Margins in Ductal Carcinoma In Situ (DCIS)

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • When a patient has a negative but close DCIS margin:
    • The margin width (distance between the edge of the DCIS and the inked margin) reflects the completeness of excision and is an important determinant of local recurrence in DCIS:
      • Particularly for patients considering omission of radiotherapy after breast-conserving surgery
  • In 2016, the Society of Surgical Oncology and American Society of Radiation Oncology developed consensus guidelines regarding margins for DCIS:
    • These guidelines were based on a meta-analysis of 22 trials enrolling 4,660 women treated with partial mastectomy and radiation therapy:
      • There was a 64% reduction in local recurrence risk in patients with negative margins compared to those with positive margins
    • Margin thresholds ≥ 2 mm were associated with fewer local recurrences
  • For patients with positive margins:
    • Either re-excision or mastectomy to achieve negative margins should be performed
  • For patients with close margins, multiple factors should be considered:
    • The volume / extent of DCIS
    • Its distribution throughout a specimen
    • The volume of the excision
    • The volume of DCIS deemed close to the margin (focal or extensive)
  • After review of pathology:
    • Re-excision and / or radiation boost should be performed
  • A post-excision mammogram:
    • May be considered to rule out residual suspicious calcifications in the partial mastectomy operative bed for targeting during re-excision:
      • Breast-conservation therapy may be re-attempted
  • If the close margins are extensive, mastectomy may be indicated
  • References
    • Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Ann Surg Oncol. 2016;23(12):3801-3810.
    • Van Zee KJ, Subhedar P, Olcese C, Patil S, Morrow M. Relationship between margin width and recurrence of ductal carcinoma in situ: analysis of 2996 women treated with breast-conserving surgery for 30 years. Ann Surg. 2015;262(4):623-631.
    • Dunne C, Burke JP, Morrow M, Kell MR. Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol. 2009;27(10):1615-1620.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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