Current margin practice and effect on re-excision rates following the publication of the SSO-ASTRO consensus and ABS consensus guidelines: a national prospective study of 2858 women undergoing breast-conserving therapy in the UK and Ireland

Publication date: October 2017
Source:European Journal of Cancer, Volume 84
Author(s): Sarah Shuk-Kay Tang, Sarantos Kaptanis, James B. Haddow, Giuseppina Mondani, Beatrix Elsberger, Marios Konstantinos Tasoulis, Christine Obondo, Neil Johns, Wisam Ismail, Asim Syed, Panayioti Kissias, Mary Venn, Souganthy Sundaramoorthy, Gareth Irwin, Amtul S. Sami, Dalia Elfadl, Alice Baggaley, Dionysios Dennis Remoundos, Fiona Langlands, Petros Charalampoudis, Zoe Barber, Werbena L.S. Hamilton-Burke, Ayesha Khan, Chiara Sirianni, Louise Anne-Marie Grant Merker, Sunita Saha, Risha Arun Lane, Sharat Chopra, Sophie Dupré, Aiden T. Manning, Edward R. St John, Aya Musbahi, Nokwanda Dlamini, Caitlin L. McArdle, Chloe Wright, James O. Murphy, Ravi Aggarwal, Matei Dordea, Karen Bosch, Donna Egbeare, Hisham Osman, Salim Tayeh, Faraz Razi, Javeria Iqbal, Serena F.C. Ledwidge, Vanessa Albert
IntroductionThere is variation in margin policy for breast conserving therapy (BCT) in the UK and Ireland. In response to the Society of Surgical Oncology and American Society for Radiation Oncology (SSO-ASTRO) margin consensus ('no ink on tumour' for invasive and 2 mm for ductal carcinoma in situ [DCIS]) and the Association of Breast Surgery (ABS) consensus (1 mm for invasive and DCIS), we report on current margin practice and unit infrastructure in the UK and Ireland and describe how these factors impact on re-excision rates.MethodsA trainee collaborative-led multicentre prospective study was conducted in the UK and Ireland between 1st February and 31st May 2016. Data were collected on consecutive BCT patients and on local infrastructure and policies.ResultsA total of 79 sites participated in the data collection (75% screening units; average 372 cancers annually, range 70–900). For DCIS, 53.2% of units accept 1 mm and 38% accept 2-mm margins. For invasive disease 77.2% accept 1 mm and 13.9% accept 'no ink on tumour'. A total of 2858 patients underwent BCT with a mean re-excision rate of 17.2% across units (range 0–41%). The re-excision rate would be reduced to 15% if all units applied SSO-ASTRO guidelines and to 14.8% if all units followed ABS guidelines. Of those who required re-operation, 65% had disease present at margin.ConclusionThere continues to be large variation in margin policy and re-excision rates across units. Altering margin policies to follow either SSO-ASTRO or ABS guidelines would result in a modest reduction in the national re-excision rate. Most re-excisions are for involved margins rather than close margins.



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