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Changes in margin re‐excision rates: Experience incorporating the “no ink on tumor” guideline into practice
Author(s) -
Patten Caitlin R.,
Walsh Kendall,
Sarantou Terry,
HadzikadicGusic Lejla,
Forster Meghan R.,
Robinson Myra,
White Richard L.
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24770
Subject(s) - guideline , medicine , margin (machine learning) , retrospective cohort study , cohort , academic institution , surgery , cohort study , pathology , machine learning , computer science , library science
Prior to the “no ink on tumor” SSO/ASTRO consensus guideline, approximately 20% of women with stage I/II breast cancers undergoing breast conservation surgery at our institution underwent margin re‐excision. On May 20, 2013, our institution changed the definition of negative margins from 2 mm to “no ink on tumor.” Methods A retrospective review was conducted of patients who had surgery at our institution with clinical stage I/II breast cancers between June 1, 2011 and May 1, 2015. In the pre‐guideline cohort (pre) and post‐guideline cohort (post), negative margins were 2 mm and “no ink on tumor,” respectively. Results Implementation of the guideline resulted in a significant decrease in the positive/close margin rate (29.6% pre vs 10.1% post; P < 0.001) and numerical decrease in re‐excision rate (20.4% pre vs 16.3% post; P = 0.104). No significant difference was found in local recurrence between the cohorts with limited follow‐up (1.2% pre vs 1.5% post; P = 0.787). Conclusion The implementation of the “no ink on tumor” guideline at our institution has resulted in a significant decrease in positive margin rates and a numerical decrease in margin re‐excisions. In addition to margin status, surgeons continue to use individual patient and histologic factors to decide for or against margin re‐excision.