Re-excision rates after breast conserving surgery following the 2014 SSO-ASTRO guidelines

In 2014, SSO-ASTRO published guidelines which recommended “no ink on tumor” as adequate margins for patients undergoing breast conservation for invasive breast cancer. In 2016, new SSO-ASTRO-ASCO guidelines recommended 2 mm margins for DCIS. We evaluated whether these guidelines affected re-excision...

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Bibliographic Details
Published in:The American journal of surgery 2017-12, Vol.214 (6), p.1104-1109
Main Authors: Heelan Gladden, Alicia A., Sams, Sharon, Gleisner, Ana, Finlayson, Christina, Kounalakis, Nicole, Hosokawa, Patrick, Brown, Regina, Chong, Tae, Mathes, David, Murphy, Colleen
Format: Article
Language:English
Subjects:
Adult
Aged
Breast cancer
Breast Neoplasms - pathology
Breast Neoplasms - surgery
Cancer therapies
Colorado
Consensus
Female
Guideline Adherence
Guidelines
Humans
Invasiveness
Margin requirements
Margins of Excision
Mastectomy
Mastectomy, Segmental - standards
Middle Aged
Oncology
Pathology
Patients
Practice Guidelines as Topic
Practice Patterns, Physicians' - standards
Quality Indicators, Health Care
Reoperation - statistics & numerical data
Studies
Surgery
Treatment Outcome
United States
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Summary:In 2014, SSO-ASTRO published guidelines which recommended “no ink on tumor” as adequate margins for patients undergoing breast conservation for invasive breast cancer. In 2016, new SSO-ASTRO-ASCO guidelines recommended 2 mm margins for DCIS. We evaluated whether these guidelines affected re-excision rates at our institution. Patients treated with breast conservation surgery from January 1, 2010–March 1, 2016 were identified. Re-excision rates, tumor characteristics, and presence of residual disease were recorded. The 2016 guidelines were retrospectively applied to the same cohort and expected re-excision rates calculated. Re-excision rates did not significantly decline before and after 2014 guideline adoption (11.9% before, 10.9% after; p = 0.65) or when the 2016 guidelines were retrospectively applied (8.4%; p = 0.10). The 2014 and 2016 guidelines had minimal impact on our re-excision rates, as most re-excisions were done for DCIS and 2016 guidelines supported our prior institutional practices of 2 mm margins for these patients.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2017.08.023