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Changes in margin re-excision rates: Experience incorporating the "no ink on tumor" guideline into practice. J Surg Oncol 2017 Dec;116(8):1040-1045



Pubmed ID




Scopus ID

2-s2.0-85026404886 (requires institutional sign-in at Scopus site)   19 Citations


INTRODUCTION: 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.

Author List

Patten CR, Walsh K, Sarantou T, Hadzikadic-Gusic L, Forster MR, Robinson M, White RL Jr


Caitlin R. Patten MD, FACS Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged, 80 and over
Breast Neoplasms
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Practice Guidelines as Topic
Retrospective Studies