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;Review;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: 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 7,883 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

  • November 2016

Published In

Volume / Issue

  • 23 / 12

Start / End Page

  • 3801 - 3810

PubMed ID

  • 27527714

Pubmed Central ID

  • PMC5047939

Electronic International Standard Serial Number (EISSN)

  • 1534-4681

Digital Object Identifier (DOI)

  • 10.1245/s10434-016-5449-z


  • eng

Conference Location

  • United States