Controversy: Surgical Margins in Breast Cancer

What is a clear margin in breast-conserving cancer surgery?

ASCO Connection (link) hosts a point-counterpoint discussion by two contributors regarding surgical margins in breast cancer that would be of general interest to surgical pathologists.  It is fairly brief (you can read in about 10 minutes) but also is well-referenced and would be a good resource to have.

The issues around surgical margin assessment and reporting is one that I find and have found vexing and exasperating. One of my professors while I was a resident refused to report margins on lumpectomies--much to the irritation of the oncologists, radiation oncologists, and surgeons--on the principle that the structure of fat and the extravasation of ink rendered any judgment of the margin status based upon the microscopic absence of (non-cauterized) recognizable tumor painted with ink meaningless. Although I couldn't understand his perspective at the time, I certainly do understand where he was coming from after years of experience and numerous clinical conversations about "close," "negative," and "positive" margins.  Yet, the "standard-of-care" dictates that we report margins, so we do.

Take a look at our colleagues' take on this subject. I found Dr. Silverstein's presentation of the split reduction excision particularly interesting and wonder if there are any readers who have had experience with this type of specimen and would be willing to "guest post" on this.