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The American Society of Breast Surgeons.
Annals of Surgical Oncology

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Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

Meena S. Moran MD, Stuart J. Schnitt MD, Armando E. Giuliano MD, Jay R. Harris MD, Seema A. Khan MD, Janet Horton MD, Suzanne Klimberg MD, Mariana Chavez-MacGregor MD, Gary Freedman MD, Nehmat Houssami MD, PhD, Peggy L. Johnson, Monica Morrow MD
Breast Oncology – Special Article
Volume 21, Issue 3 / March , 2014

Abstract

Purpose

Controversy exists regarding the optimal margin width in breast-conserving surgery for invasive breast cancer.

Methods

A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus.

Results

Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a two-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component.

Conclusion

The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

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