title: Extent of excision margin width required in breast conserving surgery for ductal carcinoma in situ.
abstract: BACKGROUND
  Breast conserving surgery (BCS) is common practice for unifocal ductal carcinoma in situ (DCIS) less than 4 cm in size, but the extent of tumor free margin width around DCIS necessary to minimize recurrence is unclear.
  
  
  METHODS
  Clinical and pathologic details were recorded from all patients with pure DCIS < 4 cm in size, treated with BCS between 1978 and 1997. Histologic margins were measured by using an ocular micrometer. Patients with clear margins (> 1 mm) were divided up into 3 groups for analysis based on margin of normal tissue excised: 1.1-5 mm, 5.1-10 mm, and 10.1-40 mm.
  
  
  RESULTS
  There were 66 patients with close margins (< or = 1 mm), of which 25 cases (37.9%) recurred. The recurrence rates for the 3 clear margin groups ranged from 4.5-7.1%. Median followup was 47 months (range 12-197 mos). Risk of recurrence in the group with close margins was greater than the subgroups with clear margins (P < 0.001); no differences in recurrence was seen between the individual subgroups with clear margins. Nuclear Grade 3 was predictive of recurrence (P = 0.03). Following excision alone, the recurrence rate was 18.6%, compared with 11.1% when radiotherapy was given as adjuvant therapy. Women with clear margins following excision had a recurrence rate of only 8.1%.
  
  
  CONCLUSIONS
  After BCS for DCIS, close margins were associated with a high risk of local recurrence. Radiotherapy did not compensate for inadequate surgical clearance.
authors.affiliation: Department of Surgery, University Hospital of South Manchester, Manchester, United Kingdom.
authors.forename: K C
authors.initials: KC
authors.lastname: Chan
authors.forename: W F
authors.initials: WF
authors.lastname: Knox
authors.forename: G
authors.initials: G
authors.lastname: Sinha
authors.forename: A
authors.initials: A
authors.lastname: Gandhi
authors.forename: L
authors.initials: L
authors.lastname: Barr
authors.forename: A D
authors.initials: AD
authors.lastname: Baildam
authors.forename: N J
authors.initials: NJ
authors.lastname: Bundred
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D018714:Radiotherapy, Adjuvant