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Annals of Surgical Oncology

, Volume 23, Issue 11, pp 3453–3458 | Cite as

Should New “No Ink On Tumor” Lumpectomy Margin Guidelines be Applied to Ductal Carcinoma In Situ (DCIS)? A Retrospective Review Using Shaved Cavity Margins

  • Andrea L. Merrill
  • Rong Tang
  • Jennifer K. Plichta
  • Upahvan Rai
  • Suzanne B. Coopey
  • Maureen P. McEvoy
  • Kevin S. Hughes
  • Michelle C. Specht
  • Michele A. Gadd
  • Barbara L. Smith
Breast Oncology

Abstract

Background

No consensus exists for clear margins for breast-conserving surgery for pure ductal carcinoma in situ (DCIS). We examined the implications of applying a “no ink on tumor” standard for pure DCIS by correlating clear margin width with rates of residual disease.

Methods

Lumpectomies with complete shaved cavity margins (SCMs) for pure DCIS at our institution from 2004 to 2007 were reviewed and patients with microinvasive cancer or multifocal disease requiring multiple wires excluded. Rates of residual disease in shaved margins were determined based on margin status of the main lumpectomy specimen using margin widths of “ink on tumor,” ≤1, >1 to <2, and ≥2 mm.

Results

Overall, 182 women undergoing lumpectomy for pure DCIS met eligibility criteria. In patients with “ink on tumor” in the main lumpectomy specimen, 88 % had residual disease in the SCMs. Rates of residual disease in SCMs for lumpectomies with margins of <2 mm (but not on ink) were 52 % compared with 13 % for lumpectomies with margins ≥2 mm (p < 0.0005). Multivariate analyses confirmed the association of lumpectomy margin width and residual tumor in shaved cavity margins. Odds of residual disease in the SCM for postmenopausal patients were 74 % less than for pre/perimenopausal women (odds ratio 0.26; confidence interval 0.08–0.82).

Conclusions

Application of a “no ink on tumor” lumpectomy margin standard to patients with DCIS results in a significant increase in the rates of residual disease in cavity margins compared with use of a ≥2-mm margin standard. Use of narrower margins may have important implications for use of adjuvant therapy.

Keywords

Residual Disease Margin Width Ipsilateral Breast Tumor Recurrence Shave Cavity Margin Comedo Necrosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosures

The authors have no conflicts of interest to disclose.

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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Andrea L. Merrill
    • 1
  • Rong Tang
    • 1
    • 2
  • Jennifer K. Plichta
    • 1
  • Upahvan Rai
    • 1
  • Suzanne B. Coopey
    • 1
  • Maureen P. McEvoy
    • 1
  • Kevin S. Hughes
    • 1
  • Michelle C. Specht
    • 1
  • Michele A. Gadd
    • 1
  • Barbara L. Smith
    • 1
  1. 1.Division of Surgical OncologyMassachusetts General HospitalBostonUSA
  2. 2.Division of Breast Surgery, Hunan Cancer HospitalThe Affiliated Tumor Hospital of Xiangya Medical School of Central South UniversityChangshaChina

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