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CME Topicgroups, respectively.13 However, in examining the LR rates mammography; as a result, a wide margin is recommendedin patients with negative margin, no clear cut differences for excision. Randomized controlled trials, namely NSABPbased on the exact margin width were found. Whether pa- B-17,3 UKCCCR,6 and EOTRC 108534,5 showed that BCTtients with close margin had a LR rate equivalent to those followed by radiotherapy reduced the risk of noninvasive andwith a positive margin, negative margin, or intermediate mar- invasive recurrences in the ipsilateral breast when comparedgin was unclear. with local excision alone. The incidence of invasive ipsilat- eral breast recurrence in patients who received radiotherapyMargins for DCIS was 3.9% and 5.8% at 5 yrs in NSABP B-17 trial and EORTC DCIS is a local disease lacking stromal invasion and 10853 trial, respectively, which was lower than the excisiondistant metastases. The presentation varies from a palpable group. Data from the pathological review of NSABP B-17mass to microcalcifications on mammography. The work by and EORTC 10853 trials showed that the risk of LR wasHolland showed that the histological size of DCIS might not higher in patients who did not have free margins.5,16 Unfor-correlate with mammographic findings.14,15 The reliability of tunately, the trial eligibility criteria did not require reportingmammography in assessing tumor size was related to both the of margin widths in all 3 trials. Only 5% of the pathologicalhistological type and the type of microcalcifications seen on reports did specify the exact distance in the EORTC trial.4,5Table 1. Summary of reported rates of local recurrence after breast-conserving therapy for ductal carcinoma insituaAuthor Margin (mm) N Management LR (%) Follow-up (mo) ConclusionSilverstein23 10 mm 93 Excision 2.2 Mean 81 No reduction in probability of LR with addition of postop RT if margin is 10 mm 10 mm 40 Excision RT 2.5 — —Kestin24 2b 44 Excision RT 5.9 Median 84 Margin status alone may not predict complete tumor extirpation adequately 2 88 Excision RT 15.1 — —Chan17 1 66 Excisionc 37.9 Median 47 Margins greater than 1 mm regardless of width of clearance was associated with a low LR 1.1–5 89 — 3.5 — — 5.1–10 28 — 7.1 — — 10 22 — 4.5 — —Vicini25 2 46 Excision RT 11.0 Median 87 Margin status alone may be suboptimal in accurately defining excision adequacy 2 99 Excision RT 2.0 — —Vargas21 2 34 Excision 13.0 Median 73 Margins 2 mm are shown to be an independent predictor of LR 2 198 Excision 4.0 — —MacDonald22 0 (transected) 32 Excision 46.7 Median 57 Margin width is the single most important factor in predicting LR after excision alone for DCIS 0.1–0.9 53 Excision 34.0 — — 1.0–1.9 20 Excision 35.0 — — 2.0–2.9 82 Excision 24.4 — — 3.0–5.9 39 Excision 20.5 — — 6.0–9.9 22 Excision 9.1 — — 10 197 Excision 4.6 — —MacDonald18 10 212 Excision 5.7 Median 53 Low risk of LR after excision alone for DCIS with margins 10 mm 10 60 Excision RT 1.7 — —West19 5 82 Excision RT 1.4 Median 97 5 mm margin plus radiation results in low rates of recurrence 10 71 Excision 6.0 — —a RT, radiotherapy; LR, local recurrence; DCIS, ductal carcinoma in situ.b Includes uncertain margin (n 3).c Majority of patients received excision only, other patient received adjuvant radiotherapy tamoxifen.Southern Medical Journal • Volume 102, Number 12, December 2009 1235
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