Tumor Resection Margin Definitions in Breast-Conserving Surgery: Systematic Review and Meta-analysis of the Current Literature

Susan G. Brouwer de Koning, Marie Jeanne T.F.D. Vrancken Peeters, Katarzyna Jóźwiak, Patrick A. Bhairosing, Theo J.M. Ruers

Research output: Contribution to journalReview article

  • 1 Citations

Abstract

Worldwide, various guidelines recommend what constitutes an adequate margin of excision for invasive breast cancer or for ductal carcinoma-in-situ (DCIS). We evaluated the use of different tumor resection margin guidelines and investigated their impact on positive margin rates (PMR) and reoperation rates (RR). Thirteen guidelines reporting on the extent of a positive margin were reviewed along with 31 studies, published between 2011 and 2016, reporting on a well-defined PMR. Studies were categorized according to the margin definition. Pooled PMR and RR were determined with random-effect models. For invasive breast cancer, most guidelines recommend a positive margin of tumor on ink. However, definitions of reported positive margins in the clinic vary from more than focally positive to the presence of tumor cells within 3 to 5 mm from the resection surface. Within the studies analyzed (59,979 patients), pooled PMRs for invasive breast cancer ranged from 9% to 36% and pooled RRs from 77% to 99%. For DCIS, guidelines vary between no DCIS on the resection surface to DCIS cells found within a distance of 2 mm from the resection edge. Pooled PMRs for DCIS varied from 4% to 23% (840 patients). Given the differences in tumor margin definition between countries worldwide, quality control data expressed as PMR or RR should be interpreted with caution. Furthermore, the overall definition for positive resection margins for both invasive disease and DCIS seems to have become more liberal.

LanguageEnglish
Pagese595-e600
JournalClinical breast cancer
Volume18
Issue number4
DOIs
StatePublished - 1 Aug 2018

Fingerprint

Carcinoma, Intraductal, Noninfiltrating
Segmental Mastectomy
Meta-Analysis
Guidelines
Reoperation
Neoplasms
Breast Neoplasms
Ink
Quality Control
Margins of Excision

Keywords

  • Ductal carcinoma in situ
  • Guidelines
  • Invasive breast cancer
  • Positive resection margin rate
  • Reoperation rate

Cite this

Brouwer de Koning, Susan G. ; Vrancken Peeters, Marie Jeanne T.F.D. ; Jóźwiak, Katarzyna ; Bhairosing, Patrick A. ; Ruers, Theo J.M./ Tumor Resection Margin Definitions in Breast-Conserving Surgery : Systematic Review and Meta-analysis of the Current Literature. In: Clinical breast cancer. 2018 ; Vol. 18, No. 4. pp. e595-e600
@article{6cb296538fd2486c90e2c057f816e238,
title = "Tumor Resection Margin Definitions in Breast-Conserving Surgery: Systematic Review and Meta-analysis of the Current Literature",
abstract = "Worldwide, various guidelines recommend what constitutes an adequate margin of excision for invasive breast cancer or for ductal carcinoma-in-situ (DCIS). We evaluated the use of different tumor resection margin guidelines and investigated their impact on positive margin rates (PMR) and reoperation rates (RR). Thirteen guidelines reporting on the extent of a positive margin were reviewed along with 31 studies, published between 2011 and 2016, reporting on a well-defined PMR. Studies were categorized according to the margin definition. Pooled PMR and RR were determined with random-effect models. For invasive breast cancer, most guidelines recommend a positive margin of tumor on ink. However, definitions of reported positive margins in the clinic vary from more than focally positive to the presence of tumor cells within 3 to 5 mm from the resection surface. Within the studies analyzed (59,979 patients), pooled PMRs for invasive breast cancer ranged from 9{\%} to 36{\%} and pooled RRs from 77{\%} to 99{\%}. For DCIS, guidelines vary between no DCIS on the resection surface to DCIS cells found within a distance of 2 mm from the resection edge. Pooled PMRs for DCIS varied from 4{\%} to 23{\%} (840 patients). Given the differences in tumor margin definition between countries worldwide, quality control data expressed as PMR or RR should be interpreted with caution. Furthermore, the overall definition for positive resection margins for both invasive disease and DCIS seems to have become more liberal.",
keywords = "Ductal carcinoma in situ, Guidelines, Invasive breast cancer, Positive resection margin rate, Reoperation rate",
author = "{Brouwer de Koning}, {Susan G.} and {Vrancken Peeters}, {Marie Jeanne T.F.D.} and Katarzyna J{\'o}źwiak and Bhairosing, {Patrick A.} and Ruers, {Theo J.M.}",
year = "2018",
month = "8",
day = "1",
doi = "10.1016/j.clbc.2018.04.004",
language = "English",
volume = "18",
pages = "e595--e600",
journal = "Clinical breast cancer",
issn = "1526-8209",
publisher = "Elsevier",
number = "4",

}

Tumor Resection Margin Definitions in Breast-Conserving Surgery : Systematic Review and Meta-analysis of the Current Literature. / Brouwer de Koning, Susan G.; Vrancken Peeters, Marie Jeanne T.F.D.; Jóźwiak, Katarzyna; Bhairosing, Patrick A.; Ruers, Theo J.M.

In: Clinical breast cancer, Vol. 18, No. 4, 01.08.2018, p. e595-e600.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Tumor Resection Margin Definitions in Breast-Conserving Surgery

T2 - Clinical breast cancer

AU - Brouwer de Koning,Susan G.

AU - Vrancken Peeters,Marie Jeanne T.F.D.

AU - Jóźwiak,Katarzyna

AU - Bhairosing,Patrick A.

AU - Ruers,Theo J.M.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Worldwide, various guidelines recommend what constitutes an adequate margin of excision for invasive breast cancer or for ductal carcinoma-in-situ (DCIS). We evaluated the use of different tumor resection margin guidelines and investigated their impact on positive margin rates (PMR) and reoperation rates (RR). Thirteen guidelines reporting on the extent of a positive margin were reviewed along with 31 studies, published between 2011 and 2016, reporting on a well-defined PMR. Studies were categorized according to the margin definition. Pooled PMR and RR were determined with random-effect models. For invasive breast cancer, most guidelines recommend a positive margin of tumor on ink. However, definitions of reported positive margins in the clinic vary from more than focally positive to the presence of tumor cells within 3 to 5 mm from the resection surface. Within the studies analyzed (59,979 patients), pooled PMRs for invasive breast cancer ranged from 9% to 36% and pooled RRs from 77% to 99%. For DCIS, guidelines vary between no DCIS on the resection surface to DCIS cells found within a distance of 2 mm from the resection edge. Pooled PMRs for DCIS varied from 4% to 23% (840 patients). Given the differences in tumor margin definition between countries worldwide, quality control data expressed as PMR or RR should be interpreted with caution. Furthermore, the overall definition for positive resection margins for both invasive disease and DCIS seems to have become more liberal.

AB - Worldwide, various guidelines recommend what constitutes an adequate margin of excision for invasive breast cancer or for ductal carcinoma-in-situ (DCIS). We evaluated the use of different tumor resection margin guidelines and investigated their impact on positive margin rates (PMR) and reoperation rates (RR). Thirteen guidelines reporting on the extent of a positive margin were reviewed along with 31 studies, published between 2011 and 2016, reporting on a well-defined PMR. Studies were categorized according to the margin definition. Pooled PMR and RR were determined with random-effect models. For invasive breast cancer, most guidelines recommend a positive margin of tumor on ink. However, definitions of reported positive margins in the clinic vary from more than focally positive to the presence of tumor cells within 3 to 5 mm from the resection surface. Within the studies analyzed (59,979 patients), pooled PMRs for invasive breast cancer ranged from 9% to 36% and pooled RRs from 77% to 99%. For DCIS, guidelines vary between no DCIS on the resection surface to DCIS cells found within a distance of 2 mm from the resection edge. Pooled PMRs for DCIS varied from 4% to 23% (840 patients). Given the differences in tumor margin definition between countries worldwide, quality control data expressed as PMR or RR should be interpreted with caution. Furthermore, the overall definition for positive resection margins for both invasive disease and DCIS seems to have become more liberal.

KW - Ductal carcinoma in situ

KW - Guidelines

KW - Invasive breast cancer

KW - Positive resection margin rate

KW - Reoperation rate

UR - http://www.scopus.com/inward/record.url?scp=85046818697&partnerID=8YFLogxK

U2 - 10.1016/j.clbc.2018.04.004

DO - 10.1016/j.clbc.2018.04.004

M3 - Review article

VL - 18

SP - e595-e600

JO - Clinical breast cancer

JF - Clinical breast cancer

SN - 1526-8209

IS - 4

ER -