Evidence map›Paper›PMID 24521674›Full record

GuidelineInternational journal of radiation oncology, biology, physics2014

Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer.

Meena S Moran, Stuart J Schnitt, Armando E Giuliano, Jay R Harris, Seema A Khan, Janet Horton, Suzanne Klimberg, Mariana Chavez-MacGregor, Gary Freedman, Nehmat Houssami and 2 more

Registry-linked trialOpen access · greenAbstract readConsensus StatementMeta-AnalysisPractice Guideline
PubMed Full text at PMC Publisher
In one paragraph

Guideline in International journal of radiation oncology, biology, physics, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02648802 (Cavity Shaving in Breast Conserving Surgery With Intraoperative Cavity Margin Assessment), which is not on this map. Cited by 187 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
187citing papers in PubMed, 6 pooled it
13.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02648802 nacompletednot on this mapstarted 2016, after this paper: background citation

Cavity Shaving in Breast Conserving Surgery With Intraoperative Cavity Margin Assessment: A Single Center,Randomized,Controlled Trial

TypeinterventionalSponsorSun Yat-Sen Memorial Hospital of Sun Yat-Sen UniversityRan2016 to 2019Enrolled181ConditionsBreast CancerArmsCavity shaving, Standardized BCS+CM assessment.
3 · Its place in the literature

Who cites it

187 citing papers in PubMed, 6 syntheses or guidelines pooled it, 481 citations in OpenAlex.

  1. Pooled it
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  6. Shared decision making in breast cancer treatment guidelines: Development of a quality assessment tool and a systematic review.Health expectations : an international journal of public participation in health care and health policy · 2020
    Pooled it
  7. Trial
  8. Detection of Circulating Tumor DNA Using a Tissue-Free Epigenomic Assay Is a Highly Prognostic Biomarker in Early-Stage Triple-Negative Breast Cancer.Clinical cancer research : an official journal of the American Association for Cancer Research · 2025
    Trial
  9. Effectiveness of mat pilates on fatigue in women with breast cancer submitted to adjuvant radiotherapy: randomized controlled clinical trial.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2023
    Trial
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127 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 11 institutions in 2 countries.

Meena S MoranDepartment of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut.
Stuart J SchnittDepartment of Pathology, Harvard Medical School, Boston, Massachusetts.
Armando E GiulianoDepartment of Surgery, Cedars Sinai Medical Center, Los Angeles, California.
Jay R HarrisDepartment of Radiation Oncology, Harvard Medical School, Boston, Massachusetts.
Seema A KhanDepartment of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Janet HortonDepartment of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
Suzanne KlimbergDepartment of Surgery, University of Arkansas for Medical Sciences, Fayetteville, Arkansas.
Mariana Chavez-MacGregorDepartment of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Gary FreedmanDepartment of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Nehmat HoussamiSchool of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Peggy L JohnsonAdvocate in Science, Susan G. Komen, Wichita, Kansas.
Monica MorrowBreast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: morrowm@mskcc.org.
Harvard University · USCedars-Sinai Medical Center · USDuke Medical Center · USMemorial Sloan Kettering Cancer Center · USNorthwestern University · USSusan G. Komen Breast Cancer Foundation · USThe University of Texas MD Anderson Cancer Center · USUniversity of Arkansas for Medical Sciences · USUniversity of Pennsylvania · USUniversity of Sydney · AUYale University · US

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI Hongbiao Carl Lekaye · 1985 to 2026
$347.4M
Tumor Evolution and Metastasis ProgramP30CA016672 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI Fabien Delerue · 1985 to 2026
$290.8M
NCI NIH HHS P30 CA008748NCI NIH HHS P30 CA016672
6 · The paper itself

Abstract

purposeTo convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. METHODS AND MATERIALS: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus.

resultsPositive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component.

conclusionsThe use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

Indexed as

ConsensusSocieties, MedicalAge FactorsAntineoplastic AgentsBreast NeoplasmsCarcinoma in SituCarcinoma, LobularChemotherapy, AdjuvantFemaleHumansMastectomy, SegmentalMedical OncologyNeoplasm, ResidualNeoplasms, Second PrimaryNeoplasm StagingRadiation OncologyAntineoplastic Agents

Identifiers

PMID24521674
PMCPMC4790083
OpenAlexW2147672773

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.