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


Authors: Morrow, M.; Van Zee, K. J.; Solin, L. J.; Houssami, N.; Chavez-MacGregor, M.; Harris, J. R.; Horton, J.; Hwang, S.; Johnson, P. L.; Marinovich, M. L.; Schnitt, S. J.; Wapnir, I.; Moran, M. S.
Article Title: 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
Abstract: Background: Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation (WBRT). 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 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 less than 2 mm alone are not an indication for mastectomy, and factors known to impact rates of IBTR should be considered in determining the need for re-excision. Conclusion: The use of a 2 mm margin as the standard for an adequate margin in DCIS treated with WBRT is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcome, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins < 2 mm. © 2016 American Society of Clinical Oncology, Society of Surgical Oncology, and American Society for Radiation Oncology.
Journal Title: Journal of Clinical Oncology
Volume: 34
Issue: 33
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2016-11-20
Start Page: 4040
End Page: 4046
Language: English
DOI: 10.1200/jco.2016.68.3573
PROVIDER: scopus
PUBMED: 27528719
PMCID: PMC5477830
DOI/URL:
Notes: Article -- Export Date: 6 December 2016 -- Source: Scopus
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MSK Authors
  1. Monica Morrow
    450 Morrow
  2. Kimberly J Van Zee
    242 Van Zee