Erschienen in:
10.05.2016 | Breast Oncology
Margins in DCIS: Does Residual Disease Provide an Answer?
verfasst von:
Monica Morrow, MD, Kimberly J. Van Zee, MS, MD
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 11/2016
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Excerpt
Minimizing tumor burden has been the guiding principle for breast cancer surgery since the days of Halsted. The recognition that clinically and radiographically unicentric carcinoma was frequently multifocal on detailed histologic examination, coupled with studies of sham lumpectomies demonstrating that 26–38 % of patients had residual carcinoma in mastectomy specimens, led many to conclude that mastectomy was the only appropriate management strategy for breast cancer.
1,
2 Fortunately, multiple, prospective, randomized trials disproved this notion, but our fixation on local disease burden remains and, in the era of breast-conserving surgery (BCS), is now focused on defining the margin width that minimizes the likelihood of residual cancer. Yet, we have known for more than 3 decades, since the first publication of the National Surgical Adjuvant Breast and Bowel Project (NSABP) B06 trial, that radiation is quite effective in treating residual disease in the breast, as that seminal trial showed that in-breast recurrence with lumpectomy alone was high, whereas with lumpectomy followed by radiation, the rate was similar to that of mastectomy.
3 In thinking about margins, it is worth remembering that the ultimate endpoint is local recurrence, not residual cancer. There is no negative margin width short of a mastectomy that guarantees the absence of cancer in the breast, and even a mastectomy does not guarantee freedom from local recurrence. …
