AI Article Synopsis
- There is ongoing debate about the best margin width in breast-conserving surgery for treating invasive breast cancer.
- A meta-analysis of 33 studies suggests that positive margins significantly increase the risk of ipsilateral breast tumor recurrence (IBTR), and wider margins do not further reduce this risk in various patient subgroups.
- The conclusion recommends using "no ink on tumor" as the standard for adequate margins, which may lead to lower recurrence rates, fewer re-excisions, better cosmetic results, and reduced healthcare costs.
Article 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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| http://dx.doi.org/10.1245/s10434-014-3481-4 | DOI Listing |
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