Journal of the American College of Surgeons
Volume 209, Issue 5 , Pages 608-613, November 2009

Attaining Negative Margins in Breast-Conservation Operations: Is There a Consensus among Breast Surgeons?

  • Sarah L. Blair, MD, FACS

      Affiliations

    • University of California San Diego, Moores Cancer Center, La Jolla, CA
    • Corresponding Author InformationCorrespondence address: Sarah Blair, MD, University of California San Diego, Moores Cancer Center, 3855 Health Sciences Dr #0987, La Jolla, CA 92093-0987
    • ,
  • Kari Thompson, MD

      Affiliations

    • Department of Surgery, University of California San Diego, La Jolla, CA
    • ,
  • Joseph Rococco, MD

      Affiliations

    • Department of Surgery, State University of New York Health Science Center at Syracuse, Syracuse, NY
    • ,
  • Vanessa Malcarne, PhD

      Affiliations

    • Department of Psychology, San Diego State University, San Diego, CA
    • ,
  • Peter D. Beitsch, MD, FACS

      Affiliations

    • Dallas Surgical Group, Dallas, TX
    • ,
  • David W. Ollila, MD, FACS

      Affiliations

    • Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC

Received 22 May 2009; received in revised form 24 July 2009; accepted 27 July 2009. published online 11 September 2009.

Background

The purpose of this survey was to ascertain the most common surgical practices for attaining negative (tumor-free) surgical margins in patients desiring breast-conservation treatment for breast cancer to see if a consensus exists for optimal treatment of patients.

Study Design

We sent a survey to 1,000 surgeons interested in the treatment of breast cancer. Three hundred eighty-one surgeons responded to this survey and 351 were used for the analysis (response rate of 38%).

Results

Answers showed a large variety in clinical practices among breast surgeons across the country. There was little intraoperative margin analysis; only 48% of surgeons examine the margins grossly with a pathologist and even fewer used frozen sections or imprint cytology. Decisions to reexcise specific margins varied greatly. For example, 57% of surgeons would never reexcise for a positive deep margin, but 53% would always reexcise for a positive anterior margin. Most importantly, there was a large range in answers about acceptable margins with ductal carcinoma in situ and invasive carcinoma. Fifteen percent of surgeons would accept any negative margin, 28% would accept a 1-mm negative margin, 50% would accept a 2-mm negative margin, 12% would accept a 5-mm negative margin, and 3% would accept a 10-mm negative margin.

Conclusions

Results of this survey highlight the wide variety of practice patterns in the US for handling surgical margins in breast-conservation treatment. This issue remains controversial, with no prevailing standard of care. Consequently, additional study is needed in the modern era of multimodality treatment to examine the minimal amount of surgical treatment necessary, in conjunction with chemotherapy and radiation, to attain adequate local control rates in breast-conservation treatment.

Abbreviations and Acronyms: BCT, breast-conservation treatment, CALGB, Cancer and Leukemia Group B, DCIS, ductal carcinoma in situ, LCIS, lobular carcinoma in situ, LVI, lymphovascular invasion

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 Disclosure Information: Nothing to disclose.

 This research was supported by a grant from the Department of Defense Idea Grant W81XWH-06-1-052.

PII: S1072-7515(09)01206-X

doi:10.1016/j.jamcollsurg.2009.07.026

Journal of the American College of Surgeons
Volume 209, Issue 5 , Pages 608-613, November 2009

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