Attaining Negative Margins in Breast-Conservation Operations: Is There a Consensus among Breast Surgeons?
- 30 November 2009
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 209 (5), 608-613
- https://doi.org/10.1016/j.jamcollsurg.2009.07.026
Abstract
The purpose of this survey was to ascertain the most common surgical practices for attaining negative (tumor-free) surgical margins in patients desiring breast-conservation treatment for breast cancer to see if a consensus exists for optimal treatment of patients. We sent a survey to 1,000 surgeons interested in the treatment of breast cancer. Three hundred eighty-one surgeons responded to this survey and 351 were used for the analysis (response rate of 38%). Answers showed a large variety in clinical practices among breast surgeons across the country. There was little intraoperative margin analysis; only 48% of surgeons examine the margins grossly with a pathologist and even fewer used frozen sections or imprint cytology. Decisions to reexcise specific margins varied greatly. For example, 57% of surgeons would never reexcise for a positive deep margin, but 53% would always reexcise for a positive anterior margin. Most importantly, there was a large range in answers about acceptable margins with ductal carcinoma in situ and invasive carcinoma. Fifteen percent of surgeons would accept any negative margin, 28% would accept a 1-mm negative margin, 50% would accept a 2-mm negative margin, 12% would accept a 5-mm negative margin, and 3% would accept a 10-mm negative margin. Results of this survey highlight the wide variety of practice patterns in the US for handling surgical margins in breast-conservation treatment. This issue remains controversial, with no prevailing standard of care. Consequently, additional study is needed in the modern era of multimodality treatment to examine the minimal amount of surgical treatment necessary, in conjunction with chemotherapy and radiation, to attain adequate local control rates in breast-conservation treatment.Keywords
This publication has 17 references indexed in Scilit:
- Do additional shaved margins at the time of lumpectomy eliminate the need for re-excision?The American Journal of Surgery, 2008
- Presence of Lobular Carcinoma In Situ Does Not Increase Local Recurrence in Patients Treated with Breast-Conserving TherapyAnnals of Surgical Oncology, 2008
- Screening for Recurrences in Patients Treated with Breast-Conserving Surgery: Is there a Role for MRI?Annals of Surgical Oncology, 2008
- Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trialsThe Lancet, 2005
- Intra-operative specimen analysis using faxitron microradiography for excision of mammographically suspicious, non-palpable breast lesionsThe Breast, 2004
- Eighteen‐year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapyCancer, 2003
- Positive surgical margins and ipsilateral breast tumor recurrence predict disease‐specific survival after breast‐conserving therapyCancer, 2003
- Twenty-Year Follow-up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast CancerThe New England Journal of Medicine, 2002
- Reanalysis and Results after 12 Years of Follow-up in a Randomized Clinical Trial Comparing Total Mastectomy with Lumpectomy with or without Irradiation in the Treatment of Breast CancerThe New England Journal of Medicine, 1995
- Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stage I and II breast cancerEuropean Journal of Cancer, 1992