This study confirms that what is important is a negative margin, not the margin size,” said Kevin S. Hughes, MD, a breast surgeon who is Co-Director of the Avon Comprehensive Breast Evaluation Center at Massachusetts General Hospital, Boston. “This is a confirmatory study of the consensus guidelines issued by the Society of Surgical Oncology and American Society for Radiation Oncology.¹ ‘Ink on tumor’ means increased rate of ipsilateral breast tumor recurrence, and ‘no ink on tumor’ means the margin is adequate,” he explained.

“In the past, larger margins were thought to decrease the risk of recurrence. These authors did not find that. The consensus guidelines state that there is little difference between 1-mm, 2-mm, and 5-mm margins in reducing the risk of local recurrence. Positive margins herald local recurrence. What we aim for is no ink on tumor, no matter what the margin width is,” Dr. Hughes continued.

Greater Awareness Needed

“The assumption that bigger margins were better led to repeat operations that we now know are unnecessary and cosmetically deforming. Now the standard of care for invasive breast cancer is no ink on tumor. The jury is still out on [ductal carcinoma in situ], but the standard will likely be the same,” he said.

“Some surgeons will still opt for bigger margins. It takes time for the new guidelines to filter down. We need to promote greater awareness about the new guidelines and have more widespread adoption. No ink on tumor is a reasonable approach to lumpectomy with the best cosmetic outcome,” Dr. Hughes said. ■

Disclosure: Dr. Hughes reported no potential conflicts of interest.

Reference

1. Moran MS, Schnitt SJ, Giuliano AE, et al: Society of Surgical Oncology–American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys 88:553-564, 2014.