Margins

a status report from the Annual Meeting of the American Society of Breast Surgeons

Jay K. Harness, Armando E. Giuliano, Barbara A Pockaj, Erinn Downs-Kelly

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Since the emergence of breast conserving surgery (BCS) as an alternative to mastectomy in the 1980's, there has been little consensus on what constitutes acceptable margins for cases of invasive breast cancer, how best to evaluate margins in the operating room, or an understanding of the challenging process of margin assessment by pathologists. The program committee for the 15th Annual Meeting of The American Society of Breast Surgeons organized a plenary session to discuss the latest thinking and guidelines for these important issues. The SSO/ASTRO Consensus Guideline on Margins for BCS was an important focus of discussion. The SSO/ASTRO consensus panelists concluded that "no ink on tumor" is an adequate surgical margin for BCS in patients with invasive breast cancers. Intraoperative strategies to decrease the incidence of positive margins include intraoperative localization techniques (wire-localization, ultrasound, radioactive seed) and intraoperative margin assessments with specimen radiography, imprint cytology, and frozen section. Studies also demonstrate the positive effect of shave margins with or without intraoperative margin assessment. The College of American Pathologists protocols for breast specimen margin evaluation consider multiple variables that can impact the proper assessment of margins. These variables include: tissue fixation time, specimen orientation, cold ischemia time, leaking ink, specimen pancaking and others that surgeons need to be aware of. Determining when "enough is enough" should not only be the application of guidelines and national standards, but also a multidisciplinary discussion between breast cancer specialists for what is right for the individual patient's unique circumstances.

Original languageEnglish (US)
Pages (from-to)3192-3197
Number of pages6
JournalAnnals of Surgical Oncology
Volume21
Issue number10
DOIs
StatePublished - Oct 1 2014

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Annual Reports
Segmental Mastectomy
Ink
Guidelines
Breast Neoplasms
Tissue Fixation
Cold Ischemia
Process Assessment (Health Care)
Mastectomy
Frozen Sections
Patient Rights
Operating Rooms
Radiography
Cell Biology
Seeds
Breast
Incidence
Neoplasms
Pathologists

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Margins : a status report from the Annual Meeting of the American Society of Breast Surgeons. / Harness, Jay K.; Giuliano, Armando E.; Pockaj, Barbara A; Downs-Kelly, Erinn.

In: Annals of Surgical Oncology, Vol. 21, No. 10, 01.10.2014, p. 3192-3197.

Research output: Contribution to journalArticle

Harness, Jay K. ; Giuliano, Armando E. ; Pockaj, Barbara A ; Downs-Kelly, Erinn. / Margins : a status report from the Annual Meeting of the American Society of Breast Surgeons. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 10. pp. 3192-3197.
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