Surgical resection margins after breast-conserving surgery: Senonetwork recommendations.
This paper reports findings of the "Focus on Controversial Areas" Working Party of the Italian Senonetwork, which was set up to improve the care of breast cancer patients. After reviewing articles in English on the MEDLINE system on breast conserving surgery for invasive carcinoma, the Working Party presents their recommendations for identifying risk factors for positive margins, suggests how to manage them so as to achieve the highest possible percentage of negative margins, and proposes standards for investigating resection margins and therapeutic approaches according to margin status. When margins are positive, approaches include re-excision, mastectomy, or, as second-line treatment, radiotherapy with a high boost dose. When margins are negative, boost administration and its dose depend on the risk of local recurrence, which is linked to biopathological tumor features and surgical margin width. Although margin status does not affect the choice of systemic therapy, it may delay the start of chemotherapy when further surgery is required.
Molecular Senology Unit, European Institute of Oncology, Milan - Italy.
Viviana
V
Galimberti
Department of Medical and Surgical Sciences, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna - Italy.
Mario
M
Taffurelli
Radiation Oncology Division, European Institute of Oncology, Milan - Italy.
Maria Cristina
MC
Leonardi
Radiation Oncology Section, University of Perugia and Santa Maria della Misericordia Hospital, Perugia - Italy.
Cynthia
C
Aristei
Breast Imaging Division, European Institute of Oncology, Milan - Italy.
Chiara
C
Trentin
Breast Imaging Division, European Institute of Oncology, Milan - Italy.
Enrico
E
Cassano
Pathology Unit, S. Croce Hospital, ASL TO 5, Moncalieri (Turin) - Italy.
Francesca
F
Pietribiasi
Molecular Senology Unit, European Institute of Oncology, Milan - Italy.
Giovanni
G
Corso
Division of Medical Senology, European Institute of Oncology, Milan - Italy.
Elisabetta
E
Munzone
Unit of Medical Oncology, Department of Oncology and Hematology, Hospital Pope John XXIII, Bergamo - Italy.
Carlo
C
Tondini
Regional Reference Center for Breast Cancer Screening, Turin - Italy.
Alfonso
A
Frigerio
University of Florence, Senonetwork Italia, Florence - Italy.
Luigi
L
Cataliotti
Pathology Unit, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna - Italy.
Donatella
D
Santini
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging; D008327:Mammography; D000072662:Margins of Excision; D015412:Mastectomy, Segmental / Q000592:standards / Q000639:trends; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D013997:Time Factors