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Assessment of Practice Patterns Following Publication of the SSO–ASTRO Consensus Guideline on Margins for Breast-Conserving Therapy in Stage I and II Invasive Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The recently published SSO–ASTRO consensus guideline on margins concluded “no ink on tumor” is the standard for an adequate margin. This study was conducted to determine how this guideline is aligned with current clinical practice.

Methods

A survey was sent to 3057 members of the American Society of Breast Surgeons. Questions assessed respondents’ clinical practice type and duration, familiarity with the guideline, and preferences for margin re-excision.

Results

Of those surveyed, 777 (25 %) responded. Most (92 %) indicated familiarity with the guideline. Of these respondents, the majority (n = 678, or 94.7 %) would re-excise all or most of the time when tumor extended to the inked margin. Very few (n = 9, or 1.3 %) would re-excise all or most of the time when tumor was within 2 mm of the margin. Over 12 % (n = 90) would re-excise all or most of the time for a triple-negative tumor within 1 mm of the margin, whereas 353 (49.6 %) would re-excise all or most of the time when imaging and pathology were discordant, and tumor was within 1 mm of multiple margins. Finally, 330 (45.8 %) would re-excise all or most of the time when multiple foci of ductal carcinoma in situ extended to within 1 mm of multiple inked margins.

Conclusions

Surgeons are in agreement to re-excise margins when tumor touches ink and generally not to perform re-excisions when tumor is close to (but not touching) the inked margin. For more complex scenarios, surgeons are utilizing their individual clinical judgment to determine the need for re-excision.

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Acknowledgment

The authors thank Lisheng Yi and Bryan Fellman for help with statistical analyses, Stephanie Deming for editorial assistance, and Antoinette Smithson for help with preparation of this manuscript.

Disclosure

Suzanne Klimberg, Ascendant Diagnostics, Medical Director, Stock Ownership

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Sarah M. DeSnyder MD, Kelly K. Hunt MD & Anthony Lucci MD

  2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Benjamin D. Smith MD

  3. Department of Radiation Oncology, Yale Cancer Center, New Haven, CT, USA

    Meena S. Moran MD

  4. Department of Surgery, University of Arkansas for Medical Sciences and Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, USA

    Suzanne Klimberg MD

Authors
  1. Sarah M. DeSnyder MD
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  2. Kelly K. Hunt MD
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  3. Benjamin D. Smith MD
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  4. Meena S. Moran MD
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  5. Suzanne Klimberg MD
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  6. Anthony Lucci MD
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Corresponding author

Correspondence to Anthony Lucci MD.

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DeSnyder, S.M., Hunt, K.K., Smith, B.D. et al. Assessment of Practice Patterns Following Publication of the SSO–ASTRO Consensus Guideline on Margins for Breast-Conserving Therapy in Stage I and II Invasive Breast Cancer. Ann Surg Oncol 22, 3250–3256 (2015). https://doi.org/10.1245/s10434-015-4666-1

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  • DOI: https://doi.org/10.1245/s10434-015-4666-1

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