title: Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ.
abstract: Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation.
  
  
  
  A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 20 studies including 7,883 patients and other published literature as the evidence base for consensus.
  
  
  
  Negative margins halve the risk of IBTR compared with positive margins defined as ink on DCIS. A 2-mm margin minimizes the risk of IBTR compared with smaller negative margins. More widely clear margins do not significantly decrease IBTR compared with 2-mm margins. Negative margins narrower than 2 mm alone are not an indication for mastectomy, and factors known to affect rates of IBTR should be considered in determining the need for re-excision.
  
  
  
  Use of a 2-mm margin as the standard for an adequate margin in DCIS treated with whole-breast irradiation is associated with lower rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins narrower than 2 mm.
authors.affiliation: Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. morrowm@mskcc.org.
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.affiliation: Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Kimberly J
authors.identifier: 0000-0001-9550-4647
authors.initials: KJ
authors.lastname: Van Zee
authors.affiliation: Department of Radiation Oncology, Albert Einstein Healthcare Network, Philadelphia, PA, USA.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Solin
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Nehmat
authors.initials: N
authors.lastname: Houssami
authors.affiliation: Departments of Medical Oncology and Health Service Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Mariana
authors.initials: M
authors.lastname: Chavez-MacGregor
authors.affiliation: Department of Radiation Oncology, Harvard Medical School, Boston, MA, USA.
authors.forename: Jay R
authors.initials: JR
authors.lastname: Harris
authors.affiliation: Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Horton
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Hwang
authors.affiliation: Advocate in Science, Susan G. Komen, Kansas City, USA.
authors.forename: Peggy L
authors.initials: PL
authors.lastname: Johnson
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: M Luke
authors.initials: ML
authors.lastname: Marinovich
authors.affiliation: Department of Pathology, Harvard Medical School, Boston, MA, USA.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Schnitt
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Wapnir
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, CT, USA.
authors.forename: Meena S
authors.initials: MS
authors.lastname: Moran
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000628:therapy*; D005260:Female; D006801:Humans; D000072662:Margins of Excision; D015412:Mastectomy, Segmental; D009364:Neoplasm Recurrence, Local; D018714:Radiotherapy, Adjuvant / Q000379:methods