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American Society of Breast Surgeons’ Practice Patterns After Publication of the SSO-ASTRO-ASCO DCIS Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation

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

Abstract

Background

The SSO-ASTRO-ASCO consensus guideline on margins for breast-conserving surgery with whole breast irradiation in ductal carcinoma in situ (DCIS) recommended a 2-mm margin. We sought to determine the impact of guideline publication on clinician practice.

Methods

A total of 3081 members of the American Society of Breast Surgeons (ASBrS) received a survey. Respondents’ clinical practice type and duration, guideline familiarity, and margin width preferences before and after publication were assessed. Clinical practice pattern differences before and after publication were investigated using McNemar’s test.

Results

A total of 767 (24.9%) of those surveyed responded. Most (92.4%) indicated guideline familiarity. Of those familiar, re-excision preference for DCIS and a positive margin remained the same before (94.4%) and after (94.3%) publication (McNemar’s test p = 1.0). Following publication, surgeons were more likely to avoid re-excision to achieve margins wider than 2-mm (82.3% pre versus 87.5% post, p = 0.002). More surgeons performed re-excision for a close margin with pure DCIS (25.9% pre versus 36.5% post, p < 0.001) and with DCIS with microinvasion (DCIS-M) (40.7% pre versus 52.3% post, p < 0.001). For patients with invasive disease with extensive intraductal component (EIC) and a close margin, preference to avoid re-excision was similar (51.2% per versus 55.2% post, p = 0.071).

Conclusion

Since guideline publication, surgeons are less likely to perform re-excision to obtain a margin greater than 2-mm and more likely to perform re-excision to obtain a 2-mm margin for both pure DCIS and DCIS-M. Preference to avoid re-excision with a close margin and EIC was similar before and after publication.

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Acknowledgments

We thank Antoinette Smithson for assistance with preparation of the manuscript.

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Authors and Affiliations

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

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

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

    Wenli Dong MS & Yu Shen PhD

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

    Benjamin D. Smith MD

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

    Meena S. Moran MD

  5. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mariana Chavez-MacGregor MD

Authors
  1. Sarah M. DeSnyder MD
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  2. Kelly K. Hunt MD
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  6. Mariana Chavez-MacGregor MD
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  8. Henry M. Kuerer MD, PhD
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Correspondence to Sarah M. DeSnyder MD.

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DeSnyder, S.M., Hunt, K.K., Dong, W. et al. American Society of Breast Surgeons’ Practice Patterns After Publication of the SSO-ASTRO-ASCO DCIS Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation. Ann Surg Oncol 25, 2965–2974 (2018). https://doi.org/10.1245/s10434-018-6580-9

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  • DOI: https://doi.org/10.1245/s10434-018-6580-9

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