Margin status in ductal carcinoma in situ of the breast

Abstract

For women with ductal carcinoma in situ, no residual disease after breast conserving surgery is one of the most important factors associated with local recurrence. Surgeons can rely on the pathologic examination of the margin and measure of margins width to indicate complete excision. Surgeon and pathologist have to do well and together to make margin can be assessed. Margin status is a prognostic factor for predicting residual disease. Margin width > 2 mm is associated with very few residual diseases. Margin status is also a prognostic factor for local recurrence. Local recurrence after margin width > 2-3 mm followed by radiotherapy is nearly equivalent to local recurrence after mastectomy. An evaluation based on margin status and other risk factors of recurrence (grade, necrosis, size and age like the Van Nuys Prognostic Index) can help clinicians to stratify patients into low-risk, intermediate risk and high-risk group of local recurrence. The validity of such index must be confirmed and margin width must be studied more precisely. Currently, breast conserving surgery with histological margin width > 2 mm followed by radiation therapy is necessary to obtain satisfactory local control. Such margin status with good aesthetic outcomes is not so easy to obtain with classic lumpectomy and oncologic breast surgery is a helpful technique.