Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut.
Department of Pathology, Harvard Medical School, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):553-64. doi: 10.1016/j.ijrobp.2013.11.012.
To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy.
A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus.
Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component.
The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.
召集一个多学科的乳房专家小组，研究切缘宽度与同侧乳房肿瘤复发（IBTR）之间的关系，并制定在保乳手术和辅助放疗背景下定义充分切缘的指南。
一个多学科共识小组使用了来自 33 项研究的切缘宽度和 IBTR 的荟萃分析（包括 28162 名患者）作为共识的主要证据基础。
与阴性切缘相比，阳性切缘（浸润性癌或导管原位癌上的墨水）与 IBTR 风险增加 2 倍相关。这种风险增加不能通过有利的生物学、内分泌治疗或放射增敏来减轻。与无肿瘤墨水相比，更广泛的清晰切缘并不能显著降低 IBTR 的发生率。没有证据表明更广泛的清晰切缘可以降低年轻患者或生物学不良、小叶癌或具有广泛导管内成分的癌症患者的 IBTR。
在多学科治疗时代，使用无肿瘤墨水作为浸润性癌充分切缘的标准与低复发率相关，并有降低再次切除率、改善美容效果和降低医疗成本的潜力。
