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Margins: A Status Report from the Annual Meeting of the American Society of Breast Surgeons

  • Breast Oncology
  • Published:
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Abstract

Since the emergence of breast conserving surgery (BCS) as an alternative to mastectomy in the 1980’s, there has been little consensus on what constitutes acceptable margins for cases of invasive breast cancer, how best to evaluate margins in the operating room, or an understanding of the challenging process of margin assessment by pathologists. The program committee for the 15th Annual Meeting of The American Society of Breast Surgeons organized a plenary session to discuss the latest thinking and guidelines for these important issues. The SSO/ASTRO Consensus Guideline on Margins for BCS was an important focus of discussion. The SSO/ASTRO consensus panelists concluded that "no ink on tumor" is an adequate surgical margin for BCS in patients with invasive breast cancers. Intraoperative strategies to decrease the incidence of positive margins include intraoperative localization techniques (wire-localization, ultrasound, radioactive seed) and intraoperative margin assessments with specimen radiography, imprint cytology, and frozen section. Studies also demonstrate the positive effect of shave margins with or without intraoperative margin assessment. The College of American Pathologists protocols for breast specimen margin evaluation consider multiple variables that can impact the proper assessment of margins. These variables include: tissue fixation time, specimen orientation, cold ischemia time, leaking ink, specimen pancaking and others that surgeons need to be aware of. Determining when "enough is enough" should not only be the application of guidelines and national standards, but also a multidisciplinary discussion between breast cancer specialists for what is right for the individual patient's unique circumstances.

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Acknowledgment

The authors would like to thank Sara L. Blair, MD (Department of Surgery, University of California, San Diego, San Diego, CA), and Erin M. Garvey, MD, and Richard J. Gray, MD (Department of Surgery, Mayo Clinic) for their assistance with the section on ‘Intraoperative Strategies to Decrease the Incidence of Positive Margins’.

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Authors and Affiliations

  1. Department of Surgery, Center for Cancer Prevention and Treatment, St. Joseph Hospital, Orange, CA, USA

    Jay K. Harness MD

  2. Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA

    Armando E. Giuliano MD

  3. Department of Surgery, Mayo Clinic, Phoenix, AZ, USA

    Barbara A. Pockaj MD

  4. Department of Pathology, Huntsman Cancer Center, University of Utah, Salt Lake City, UT, USA

    Erinn Downs-Kelly DO

Authors
  1. Jay K. Harness MD
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  2. Armando E. Giuliano MD
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  3. Barbara A. Pockaj MD
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  4. Erinn Downs-Kelly DO
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Correspondence to Jay K. Harness MD.

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Harness, J.K., Giuliano, A.E., Pockaj, B.A. et al. Margins: A Status Report from the Annual Meeting of the American Society of Breast Surgeons. Ann Surg Oncol 21, 3192–3197 (2014). https://doi.org/10.1245/s10434-014-3957-2

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  • DOI: https://doi.org/10.1245/s10434-014-3957-2

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