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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2015

01-10-2015 | Breast Oncology

Assessment of Practice Patterns Following Publication of the SSO–ASTRO Consensus Guideline on Margins for Breast-Conserving Therapy in Stage I and II Invasive Breast Cancer

Authors: Sarah M. DeSnyder, MD, Kelly K. Hunt, MD, Benjamin D. Smith, MD, Meena S. Moran, MD, Suzanne Klimberg, MD, Anthony Lucci, MD

Published in: Annals of Surgical Oncology | Issue 10/2015

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Abstract

Background

The recently published SSO–ASTRO consensus guideline on margins concluded “no ink on tumor” is the standard for an adequate margin. This study was conducted to determine how this guideline is aligned with current clinical practice.

Methods

A survey was sent to 3057 members of the American Society of Breast Surgeons. Questions assessed respondents’ clinical practice type and duration, familiarity with the guideline, and preferences for margin re-excision.

Results

Of those surveyed, 777 (25 %) responded. Most (92 %) indicated familiarity with the guideline. Of these respondents, the majority (n = 678, or 94.7 %) would re-excise all or most of the time when tumor extended to the inked margin. Very few (n = 9, or 1.3 %) would re-excise all or most of the time when tumor was within 2 mm of the margin. Over 12 % (n = 90) would re-excise all or most of the time for a triple-negative tumor within 1 mm of the margin, whereas 353 (49.6 %) would re-excise all or most of the time when imaging and pathology were discordant, and tumor was within 1 mm of multiple margins. Finally, 330 (45.8 %) would re-excise all or most of the time when multiple foci of ductal carcinoma in situ extended to within 1 mm of multiple inked margins.

Conclusions

Surgeons are in agreement to re-excise margins when tumor touches ink and generally not to perform re-excisions when tumor is close to (but not touching) the inked margin. For more complex scenarios, surgeons are utilizing their individual clinical judgment to determine the need for re-excision.
Literature
1.
Fisher B, Rn R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1989;320(13):822–8.CrossRefPubMed
2.
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–32.CrossRefPubMed
3.
Blichert-Toft M, Nielsen M, During M, et al. Long-term results of breast conserving surgery vs. mastectomy for early stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol. Acta Oncol. 2008;47(4):672–81.CrossRefPubMed
4.
Jacobson JA, Danforth DN, Cowan KH, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med. 1995;332(14):907–11.CrossRefPubMed
5.
Sarrazin D, Le MG, Arriagada R, et al. Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer. Radiother Oncol. 1989;14(3):177–184.CrossRefPubMed
6.
van Dongen JA, Bartelink H, Fentiman IS, et al. Randomized clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer, EORTC 10801 trial. J Natl Cancer Instit Monographs. 1992(11):15–18.
7.
Taghian A, Mohiuddin M, Jagsi R, Goldberg S, Ceilley E, Powell S. Current perceptions regarding surgical margin status after breast-conserving therapy: results of a survey. Ann Surg. 2005;241(4):629–39.PubMedCentralCrossRefPubMed
8.
Azu M, Abrahamse P, Katz SJ, Jagsi R, Morrow M. What is an adequate margin for breast-conserving surgery? Surgeon attitudes and correlates. Ann Surg Oncol. 2010;17(2):558–63.PubMedCentralCrossRefPubMed
9.
McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012;307(5):467–75.CrossRefPubMed
10.
Olsen MA, Nickel KB, Margenthaler JA, et al. Increased risk of surgical site infection among breast-conserving surgery re-excisions. Ann Surg Oncol. 2015;22(6):2003–9.CrossRefPubMed
11.
Greenup RA, Peppercorn J, Worni M, Hwang ES. Cost implications of the SSO-ASTRO consensus guideline on margins for breast-conserving surgery with whole breast irradiation in stage I and II invasive breast cancer. Ann Surg Oncol. 2014;21(5):1512–4.CrossRefPubMed
12.
King TA, Sakr R, Patil S, et al. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol. 2011;29(16):2158–64.CrossRefPubMed
13.
Moran MS, Schnitt SJ, Giuliano AE, et al. 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. J Clin Oncol. 2014;32(14):1507–15.CrossRefPubMed
14.
Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014;21(3):717–30.CrossRefPubMed
15.
Hunt KK, Smith BD, Mittendorf EA. The controversy regarding margin width in breast cancer: enough is enough. Ann Surg Oncol. 2014;21(3):701–3.CrossRefPubMed
16.
Wazer DE, Schmidt-Ullrich RK, Ruthazer R, et al. Factors determining outcome for breast-conserving irradiation with margin-directed dose escalation to the tumor bed. Int J Radiat Oncol Biol Phys. 1998;40(4):851–8.CrossRefPubMed
17.
Mansfield CM, Komarnicky LT, Schwartz GF, et al. Ten-year results in 1070 patients with stages I and II breast cancer treated by conservative surgery and radiation therapy. Cancer. 1995;75(9):2328–36.CrossRefPubMed
18.
Jones HA, Antonini N, Hart AA, et al. Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol. 2009;27(30):4939–47.PubMedCentralCrossRefPubMed
19.
Schnitt SJ, Connolly JL, Khettry U, et al. Pathologic findings on re-excision of the primary site in breast cancer patients considered for treatment by primary radiation therapy. Cancer. 1987;59(4):675–81.CrossRefPubMed
20.
Holland R, Connolly JL, Gelman R, et al. The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol. 1990;8(1):113–8.PubMed
21.
Buchholz TA, Somerfield MR, Griggs JJ, et al. Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol. 2014;32(14):1502–6.CrossRefPubMed
Metadata
Title
Assessment of Practice Patterns Following Publication of the SSO–ASTRO Consensus Guideline on Margins for Breast-Conserving Therapy in Stage I and II Invasive Breast Cancer
Authors
Sarah M. DeSnyder, MD
Kelly K. Hunt, MD
Benjamin D. Smith, MD
Meena S. Moran, MD
Suzanne Klimberg, MD
Anthony Lucci, MD
Publication date
01-10-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 10/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4666-1

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