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¹Breast Surgery Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. morrowm@mskcc.org

Breast (Edinburgh, Scotland)

|November 17, 2009

Summary

Defining adequate negative margins for invasive cancer and ductal carcinoma in situ (DCIS) remains unclear. Tumor touching ink increases local recurrence risk, but wider margins beyond "no tumor touching ink" or 2mm for DCIS lack strong supporting evidence.

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Area of Science:

Oncology
Surgical Pathology

Background:

The definition of an adequate negative margin for invasive cancer and ductal carcinoma in situ (DCIS) lacks standardization.
Current definitions, such as "tumor not touching ink," are used in randomized trials, but their universal adequacy is debated.

Purpose of the Study:

To evaluate the evidence supporting different definitions of negative margins in invasive cancer and DCIS.
To assess the impact of margin status on local recurrence (LR) risk.

Main Methods:

Review of randomized trials and existing literature on margin definitions and their correlation with local recurrence.
Analysis of factors influencing local recurrence risk beyond margin status.

Main Results:

Tumor touching ink, for both invasive cancer and DCIS, is associated with an increased risk of local recurrence.

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Convincing evidence for the benefit of margins wider than "tumor not touching ink" in invasive cancer is lacking.

For DCIS treated with radiotherapy, evidence supporting margins wider than 2mm is also insufficient.

Conclusions:

The definition of adequate negative margins requires further clarification, considering the variability in pathological processing techniques.
The clinical significance of margins larger than "tumor not touching ink" (invasive cancer) or 2mm (DCIS) should be weighed against other known factors influencing local recurrence risk.