Current Guidelines for Acceptable Surgical Margins in Breast Conservation Therapy

Abstract

Patients treated with breast-conserving surgery for early stage breast cancer should preferably have a negative resection margin prior to postoperative radiation in order to minimize the risk for local recurrence. However, selected patients with focal margin involvement are still reasonable candidates for radiation without re-excision, particularly when the margin is at an anatomic boundary of the breast. Routine use of re-excision for close margins <1–2 mm is no longer routinely required—recent data have not confirmed a benefit to margins wider than no tumor on ink. Margins may have become of lesser prognostic importance in today’s environment due to improved preoperative imaging, careful surgical and pathological correlation, and modern systemic therapy. Clinical judgment is still needed in cases of close resection margins, such as when diffuse persistent disease is suspected, to weigh the need for re-excision prior to radiation.