Abstract
Background:Breast conservation therapy (BCT) has become the standard of treatment for early stage breast cancer, and the surgical margin was one of the important factors that affected risk of local recurrence. This review looks at the safe margin for BCT in early stage invasive breast cancer and ductal carcinoma in situ (DCIS).Methods:Published literature abstracted in Medline was searched using the gateway site from the US National Library of Medicine.Conclusions:A positive margin is associated with increased risk of local recurrence after BCT for invasive breast cancer and DCIS. However there was no cut off for the margin width and the significance of a close margin remains controversial. It was generally accepted that the risk of local recurrence was low if the margin was ≥10 mm while margins that were <2 mm were considered inadequate. The surgeon needs to balance the risk between local recurrence and cosmesis in planning BCT so that the prognosis is not compromised.
This content is limited to qualifying members.
If you have an existing account please login now to access this article or view purchase options.
Create a free account, then purchase this article to download or access it online for 24 hours.
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
References
References1. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227–1232.VeronesiU]]CascinelliN]]MarianiL&etal;Twenty-year follow up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer.N Engl J Med20023471227-12322. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus radiation for the treatment of breast cancer. N Engl J Med 2002;347:1233–1241.FisherB]]AndersonS]]BryantJ&etal;Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus radiation for the treatment of breast cancer.N Engl J Med20023471233-12413. Fisher B, Costantino J, Redmond C, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med 1993;328:1581–1586.FisherB]]CostantinoJ]]RedmondC&etal;Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer.N Engl J Med19933281581-15864. Julien JP, Bijker N, Fentiman IS, et al. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. Lancet 2000;355:528–533.JulienJP]]BijkerN]]FentimanIS&etal;Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group.Lancet2000355528-5335. Bijker N, Peterse JL, Duchateau L, et al. Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: analysis of European Organization for Research and Treatment of Cancer Trial 10853. J Clin Oncol 2001;19:2263–2271.BijkerN]]PeterseJL]]DuchateauL&etal;Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: analysis of European Organization for Research and Treatment of Cancer Trial 10853.J Clin Oncol2001192263-22716. Houghton J, George WD, Cuzick J, et al; UK Coordinating Committee on Cancer Research; Ductal Carcinoma in situ Working Party; DCIS trialists in the UK, Australia, and New Zealand. Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: Randomised controlled trial. Lancet 2003;362:95–102.HoughtonJ]]GeorgeWD]]CuzickJ&etal;UK Coordinating Committee on Cancer ResearchDuctal Carcinoma in situ Working PartyDCIS trialists in the UK, Australia, and New ZealandRadiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: Randomised controlled trial.Lancet200336295-1027. Veronesi U, Volterrani F, Luini A, et al. Quadrantectomy versus lumpectomy for small size breast cancer. Eur J Cancer 1990;26:671–673.VeronesiU]]VolterraniF]]LuiniA&etal;Quadrantectomy versus lumpectomy for small size breast cancer.Eur J Cancer199026671-6738. van Dongen JA, Bartelink H, Fentiman IS, et al. 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 cancer. Eur J Cancer 1992;28A:801–805.van DongenJA]]BartelinkH]]FentimanIS&etal;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 cancer.Eur J Cancer199228A801-8059. DiBiase SJ, Komarnicky LT, Schwartz GF, et al. The number of positive margins influences the outcome of women treated with breast preservation for early stage breast carcinoma. Cancer 1998;82:2212–2220.DiBiaseSJ]]KomarnickyLT]]SchwartzGF&etal;The number of positive margins influences the outcome of women treated with breast preservation for early stage breast carcinoma.Cancer1998822212-222010. Mansfield CM, Komarnicky LT, Schwartz GF, et al. Ten-year results in 1070 patients with stages I and II breast cancer treated by conservative surgery and radiation therapy. Cancer 1995;75:2328–2336.MansfieldCM]]KomarnickyLT]]SchwartzGF&etal;Ten-year results in 1070 patients with stages I and II breast cancer treated by conservative surgery and radiation therapy.Cancer1995752328-233611. Gage I, Schnitt SJ, Nixon AJ, et al. Pathologic margin involvement and the risk of recurrence in patients treated with breast conserving therapy. Cancer 1996;78:1921–1928.GageI]]SchnittSJ]]NixonAJ&etal;Pathologic margin involvement and the risk of recurrence in patients treated with breast conserving therapy.Cancer1996781921-192812. Peterson ME, Schultz DJ, Reynolds C, et al. Outcomes in breast cancer patients relative to margin status after treatment with breast-conserving surgery and radiation therapy: the University of Pennsylvania experience. Int J Radiat Oncol Biol Phys 1999;43:1029–1035.PetersonME]]SchultzDJ]]ReynoldsC&etal;Outcomes in breast cancer patients relative to margin status after treatment with breast-conserving surgery and radiation therapy: the University of Pennsylvania experience.Int J Radiat Oncol Biol Phys1999431029-103513. Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg 2002;184:383–393.SingletarySESurgical margins in patients with early-stage breast cancer treated with breast conservation therapy.Am J Surg2002184383-39314. Holland R, Hendriks JH, Vebeek AL, et al. Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ. Lancet 1990;335:519–522.HollandR]]HendriksJH]]VebeekAL&etal;Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ.Lancet1990335519-52215. Holland R, Peterse JL, Millis RR, et al. Ductal carcinoma in situ: a proposal for a new classification. Semin Diagn Pathol 1994;11:167–180.HollandR]]PeterseJL]]MillisRR&etal;Ductal carcinoma in situ: a proposal for a new classification.Semin Diagn Pathol199411167-18016. Fisher ER, Costantino J, Fisher B, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) protocol B-17. Intraductal carcinoma (ductal carcinoma in situ). The National Surgical Adjuvant Breast and Bowel Project Collaborating Investigators. Cancer 1995;75:1310–1319.FisherER]]CostantinoJ]]FisherB&etal;Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) protocol B-17. Intraductal carcinoma (ductal carcinoma in situ). The National Surgical Adjuvant Breast and Bowel Project Collaborating Investigators.Cancer1995751310-131917. Chan KC, Knox WF, Sinha G, et al. Extent of excision margin width required in breast conserving surgery for ductal carcinoma in situ. Cancer 2001;91:9–16.ChanKC]]KnoxWF]]SinhaG&etal;Extent of excision margin width required in breast conserving surgery for ductal carcinoma in situ.Cancer2001919-1618. MacDonald HR, Silverstein MJ, Lee LA, et al. Margin width as the sole determinant of local recurrence after breast conservation in patients with ductal carcinoma in situ of the breast. Am J Surg 2006;192:420–422.MacDonaldHR]]SilversteinMJ]]LeeLA&etal;Margin width as the sole determinant of local recurrence after breast conservation in patients with ductal carcinoma in situ of the breast.Am J Surg2006192420-42219. West JG, Qureshi A, Liao SY, et al. Multidisciplinary management of ductal carcinoma in situ: a 10-year experience. Am J Surg 2007;194:532–534.WestJG]]QureshiA]]LiaoSY&etal;Multidisciplinary management of ductal carcinoma in situ: a 10-year experience.Am J Surg2007194532-53420. Neuschatz AC, DiPetrillo T, Steinhoff M, et al. The value of breast lumpectomy margin assessment as a predictor of residual tumor burden in ductal carcinoma in situ of the breast. Cancer 2002;94:1917–1924.NeuschatzAC]]DiPetrilloT]]SteinhoffM&etal;The value of breast lumpectomy margin assessment as a predictor of residual tumor burden in ductal carcinoma in situ of the breast.Cancer2002941917-192421. Vargas C, Kestin L, Go N, et al. Factors associated with local recurrence and cause-specific survival in patients with ductal carcinoma in situ of the breast treated with breast-conserving therapy or mastectomy. Int J Radiat Oncol Biol Phys 2005;63:1514–1521.VargasC]]KestinL]]GoN&etal;Factors associated with local recurrence and cause-specific survival in patients with ductal carcinoma in situ of the breast treated with breast-conserving therapy or mastectomy.Int J Radiat Oncol Biol Phys2005631514-152122. MacDonald HR, Silverstein MJ, Mabry H, et al. Local control in ductal carcinoma in situ treated by excision alone: incremental benefit of larger margins. Am J Surg 2005;190:521–525.MacDonaldHR]]SilversteinMJ]]MabryH&etal;Local control in ductal carcinoma in situ treated by excision alone: incremental benefit of larger margins.Am J Surg2005190521-52523. Silverstein MJ, Lagios MD, Groshen S, et al. The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 1999;340:1455–1461.SilversteinMJ]]LagiosMD]]GroshenS&etal;The influence of margin width on local control of ductal carcinoma in situ of the breast.N Engl J Med19993401455-146124. Kestin LL, Goldstein NS, Lacerna MD, et al. Factors associated with local recurrence of mammographically detected ductal carcinoma in situ in patients given breast-conserving therapy. Cancer 2000;88:596–607.KestinLL]]GoldsteinNS]]LacernaMD&etal;Factors associated with local recurrence of mammographically detected ductal carcinoma in situ in patients given breast-conserving therapy.Cancer200088596-60725. Vicini FA, Kestin LL, Goldstein NS, et al. Relationship between excision volume, margin status and tumor size with the development of local recurrence in patients with ductal carcinoma in situ treated with breast-conserving therapy. J Surg Oncol 2001;76:245–254.ViciniFA]]KestinLL]]GoldsteinNS&etal;Relationship between excision volume, margin status and tumor size with the development of local recurrence in patients with ductal carcinoma in situ treated with breast-conserving therapy.J Surg Oncol200176245-25426. Silverstein MJ, Lagios MD, Craig PH, et al. A prognostic index for ductal carcinoma in situ of the breast. Cancer 1996;77:2267–2274.SilversteinMJ]]LagiosMD]]CraigPH&etal;A prognostic index for ductal carcinoma in situ of the breast.Cancer1996772267-227427. Silverstein MJ. The University of Southern California/Van Nuys prognostic index for ductal carcinoma in situ of the breast. Am J Surg 2003;186:337–343.SilversteinMJThe University of Southern California/Van Nuys prognostic index for ductal carcinoma in situ of the breast.Am J Surg2003186337-34328. National Comprehensive Cancer Network. Clinical Practice Guidelines in oncology–Breast Cancer, v2.2008 [PDF on Internet]. Available at: www.nccn.org. Accessed April 3, 2008.29. Papa MZ, Zippel D, Koller M, et al. Positive margins of breast biopsy: is reexcision always necessary? J Surg Oncol 1999;70:167–171.PapaMZ]]ZippelD]]KollerM&etal;Positive margins of breast biopsy: is reexcision always necessary?J Surg Oncol199970167-17130. Luini A, Rososchansky J, Gatti G, et al. The surgical margin after breast-conserving surgery: discussion of an open issue. Breast Cancer Res Treat 2009;113:397–402.LuiniA]]RososchanskyJ]]GattiG&etal;The surgical margin after breast-conserving surgery: discussion of an open issue.Breast Cancer Res Treat2009113397-40231. Cabioglu N, Hunt KK, Sahin AA, et al. Role of intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol 2007;14:1458–1471.CabiogluN]]HuntKK]]SahinAA&etal;Role of intraoperative margin assessment in patients undergoing breast-conserving surgery.Ann Surg Oncol2007141458-147132. Olson TP, Harter J, Muñoz A, et al. Frozen section analysis for intraoperative margin assessment during breast-conserving surgery results in low rates of re-excision and local recurrence. Ann Surg Oncol 2007;14:2953–2960.OlsonTP]]HarterJ]]MuñozA&etal;Frozen section analysis for intraoperative margin assessment during breast-conserving surgery results in low rates of re-excision and local recurrence.Ann Surg Oncol2007142953-296033. Weinberg E, Cox C, Dupont E, et al. Local recurrence in lumpectomy patients after imprint cytology margin evaluation. Am J Surg 2004;188:349–54.WeinbergE]]CoxC]]DupontE&etal;Local recurrence in lumpectomy patients after imprint cytology margin evaluation.Am J Surg2004188349-5434. Bakhshandeh M, Tutuncuoglu SO, Fischer G, et al. Use of imprint cytology for assessment of surgical margins in lumpectomy specimens of breast cancer patients. Diagn Cytopathol 2007;35:656–659.BakhshandehM]]TutuncuogluSO]]FischerG&etal;Use of imprint cytology for assessment of surgical margins in lumpectomy specimens of breast cancer patients.Diagn Cytopathol200735656-65935. Moore MM, Whitney LA, Cerilli, et al. Intraoperative ultrasound is associated with clear lumpectomy margins for palpable infiltrating ductal breast carcinoma. Ann Surg 2001;233:761–768.MooreMM]]WhitneyLA]]Cerilli&etal;Intraoperative ultrasound is associated with clear lumpectomy margins for palpable infiltrating ductal breast carcinoma.Ann Surg2001233761-76836. Mazouni C, Rouzier R, Balleyguier C, et al. Specimen radiography as predictor of resection margin status in non-palpable breast lesions. Clin Radiol 2006;61:789–796.MazouniC]]RouzierR]]BalleyguierC&etal;Specimen radiography as predictor of resection margin status in non-palpable breast lesions.Clin Radiol200661789-79637. Clough KB, Lewis JS, Couturaud B, et al. Oncoplastic techniques allow extensive resection for breast-conserving therapy of breast carcinomas. Ann Surg 2003;237:26–34.CloughKB]]LewisJS]]CouturaudB&etal;Oncoplastic techniques allow extensive resection for breast-conserving therapy of breast carcinomas.Ann Surg200323726-3438. Asgeirsson KS, Rasheed T, McCulley SJ, et al. Oncoplastic and cosmetic outcomes of oncoplastic breast conserving therapy. Eur J Surg Oncol 2005;31:817–823.AsgeirssonKS]]RasheedT]]McCulleySJ&etal;Oncoplastic and cosmetic outcomes of oncoplastic breast conserving therapy.Eur J Surg Oncol200531817-82339. Rietjens M, Urban CA, Rey PC, et al. Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast 2007;16:387–395.RietjensM]]UrbanCA]]ReyPC&etal;Long-term oncological results of breast conservative treatment with oncoplastic surgery.Breast200716387-39540. von Smitten K. Margin status after breast-conserving treatment of breast cancer: how much free margin is enough? J Surg Oncol 2008;98:585–587.von SmittenKMargin status after breast-conserving treatment of breast cancer: how much free margin is enough?J Surg Oncol200898585-58741. Meijnen P, Gilhuijs KG, Rutgers EJ. The effects of margins on the clinical management of ductal carcinoma in situ of the breast. J Surg Oncol 2008;98:579–584.MeijnenP]]GilhuijsKG]]RutgersEJThe effects of margins on the clinical management of ductal carcinoma in situ of the breast.J Surg Oncol200898579-584