Margins in breast cancer: How much is enough?

Abstract

The appropriate negative margin width for women undergoing breast-conserving surgery for both ductal carcinoma in situ (DCIS) and invasive carcinoma is controversial. This review examines the available data on the margin status for invasive breast cancer and DCIS, and highlights the similarities and differences in tumor biology and standard treatments that affect the local recurrence (LR) risk and, therefore, the optimal surgical margin. Consensus guidelines support a negative margin, defined as no ink on tumor, for invasive carcinoma treated with breast-conserving therapy. Because of differences in the growth pattern and utilization of systemic therapy, a margin of 2 mm has been found to minimize the LR risk for women with DCIS undergoing lumpectomy and radiation therapy (RT). Wider negative margins do not improve local control for DCIS or invasive carcinoma when they are treated with lumpectomy and RT. Re-excision for negative margins should be individualized, and the routine practice of performing additional surgery to obtain a wider negative margin is not supported by the literature. Cancer 2018;124:1335-41. © 2018 American Cancer Society.

pHLIP ICG for delineation of tumors and blood flow during fluorescence-guided surgery

“…The goal is to remove the tumor mass and, at the same time, preserve as much healthy tissue as possible. Unfortunately, ~ 25% of patients with invasive carcinoma and one-third of those with ductal carcinoma in situ require re-excision with about half of the re-excisions done in patients with negative margins, defined as “no ink on tumor” 48 , 49 . Two factors are known to have an important role: the process of identification of tumor negative margins and breast cancer biology.…”

Intervaginal space injection of a liquid metal can prevent breast cancer invasion and better-sustain concomitant resistance

“…The negative margin width for the surgical resection of BC is related to the risk of recurrence. 8 To reduce recurrence involving the CW, many studies have focused on methods for the intraoperative determination of tumor margins, including magnetic resonance imaging (MRI), computed tomography and invisible near-infrared fluorescent light imaging. [9][10][11][12][13] In addition, treatment of locally advanced BC that has not invaded the CW requires recognizing the negative tumor margins.…”

“…3 However, the optical negative margin width is still controversial regarding minimizing the recurrence risk after the surgical resection of BC. 8,[14][15][16] More effective methods are needed to reduce CW invasion. In recent years, the biological utilisation of the intervaginal space in medical applications has been emerging.…”

Does Age Matter? Estimating Risks of Locoregional Recurrence After Breast-conservative Surgery

“…Nevertheless, side-effects of BCT consist of scaring, skin changes, poor aesthetic result, reoperation due to insufficient margin width and locoregional recurrence (LR). Adjuvant RT can cause skin tenderness and potential long-term effects of radiotherapy namely arm pain and lung damage (34,35). Since 2014, in order to reduce Reoperation Rate (ROR), the Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) developed consensus guidelines defining negative margins as "No Ink on Tumor" and as 2 mm for BC and ductal carcinoma in situ (DCIS), respectively (36,37).…”