title: 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.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, CT, USA.
authors: Meena S
authors: MS
authors: Moran
authors: Stuart J
authors: SJ
authors: Schnitt
authors: Armando E
authors: AE
authors: Giuliano
authors: Jay R
authors: JR
authors: Harris
authors: Seema A
authors: SA
authors: Khan
authors: Janet
authors: J
authors: Horton
authors: Suzanne
authors: S
authors: Klimberg
authors: Mariana
authors: M
authors: Chavez-MacGregor
authors: Gary
authors: G
authors: Freedman
authors: Nehmat
authors: N
authors: Houssami
authors: Peggy L
authors: PL
authors: Johnson
authors: Monica
authors: M
authors: Morrow
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000592:standards*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D018787:Radiation Oncology / Q000592:standards*; D011878:Radiotherapy / Q000592:standards*; D012955:Societies, Medical / Q000458:organization & administration