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.
Journal Article (Journal Article;Systematic Review)
PURPOSE: Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation. METHODS AND MATERIALS: A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 20 studies including 7883 patients and other published literature as the evidence base for consensus. RESULTS: Negative margins halve the risk of IBTR compared with positive margins defined as ink on DCIS. A 2-mm margin minimizes the risk of IBTR compared with smaller negative margins. More widely clear margins do not significantly decrease IBTR compared with 2-mm margins. Negative margins narrower than 2 mm alone are not an indication for mastectomy, and factors known to affect rates of IBTR should be considered in determining the need for re-excision. CONCLUSION: Use of a 2-mm margin as the standard for an adequate margin in DCIS treated with whole-breast irradiation is associated with lower rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins narrower than 2 mm.
Full Text
Duke Authors
Cited Authors
- Morrow, M; Van Zee, KJ; Solin, LJ; Houssami, N; Chavez-MacGregor, M; Harris, JR; Horton, J; Hwang, S; Johnson, PL; Marinovich, ML; Schnitt, SJ; Wapnir, I; Moran, MS
Published Date
- September 2016
Published In
Volume / Issue
- 6 / 5
Start / End Page
- 287 - 295
PubMed ID
- 27538810
Pubmed Central ID
- PMC5070537
Electronic International Standard Serial Number (EISSN)
- 1879-8519
Digital Object Identifier (DOI)
- 10.1016/j.prro.2016.06.011
Language
- eng
Conference Location
- United States