Evidence map›Paper›PMID 41949686›Full record

ArticleBreast cancer (Tokyo, Japan)2026

Changes in re-excision rates after publication of guidelines defining positive margins for breast-conserving surgery: a collaborative study of the Japanese breast cancer society.

Takehiko Sakai, Yuri Kimura, Makoto Ishitobi, Atsushi Yoshida, Yasuaki Sagara, Yuka Ono, Koji Takada, Yuko Takahashi, Takahiro Tsukioki, Mao Kimoto and 2 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Breast cancer (Tokyo, Japan), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

12 authors.

Takehiko SakaiDepartment of Breast Surgical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-0081, Japan. takehiko.sakai@jfcr.or.jp.ORCID http://orcid.org/0000-0002-4982-951X
Yuri KimuraDepartment of Breast Surgical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-0081, Japan.
Makoto IshitobiDepartment of Breast Surgery, Osaka Habikino Medical Center, Osaka, Japan.
Atsushi YoshidaDepartment of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
Yasuaki SagaraDepartment of Breast and Thyroid Surgical Oncology, Social Medical Corporation Hakuaikai Sagara Hospital, Kagoshima, Japan.
Yuka OnoDepartment of Radiation Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Koji TakadaDepartment of Breast Surgical Oncology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Yuko TakahashiDepartment of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.
Takahiro TsukiokiDepartment of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.
Mao KimotoDepartment of Breast Surgery, Mie University School of Medicine, Tsu, Japan.
Tomo OsakoDivision of Pathology, The Cancer Institute of Japanese Foundation for Cancer Research, Tokyo, Japan.
Collaborative Study Group of Scientific Research of the Japanese Breast Cancer Society

Funding

Japanese Breast Cancer Society 2023-24
6 · The paper itself

Abstract

backgroundThe 2014 SSO-ASTRO consensus guidelines redefined a positive margin requiring re-excision after breast-conserving surgery (BCS) as “tumor on ink,” with several studies internationally demonstrating decreased re-excision rates thereafter. In Japan, this definition has been explicitly incorporated into the 2018 Japanese Breast Cancer Society (JBCS) guidelines; however, its impact on national clinical practice remains unclear.

methodsWe conducted a nationwide questionnaire survey of 521 JBCS-accredited institutions regarding BCS practices, imaging, surgery, margin assessment, and re-excision rates before and after 2018. In parallel, a multicenter retrospective cohort study from seven institutions analyzed positive margins and re-excision trends between 2008 and 2022.

resultsOverall, 262 institutions (response rate 55.7%) participated in the survey. Institutions reporting a positive margin rate of 0–10% increased from 47 to 63% in 2018. Institutions with a re-excision rate of 0–10% increased from 45 to 49%. In a cohort study of 18,688 BCS cases, positive margin rates fell from 11.2% (2008–14) to10.1% (2015–18) and 7.9% (2019–22), and re-excision rates from 7.6% to 6.6% and 4.9%. Multivariate analysis identified younger age, invasive lobular carcinoma, larger tumor size, lymph node positivity, and earlier surgical period as significant predictors of re-excision.

conclusionsThis nationwide study demonstrates that the implementation of international and domestic guidelines has contributed to a significant yet gradual reduction in re-excision rates following BCS in Japan. These improvements reflect Japan's already-low positive margin and re-excision rates, which have been maintained through rigorous comprehensive margin assessment methodologies.

Indexed as

Breast NeoplasmsMargins of ExcisionMastectomy, SegmentalPractice Guidelines as TopicReoperationAgedEast Asian PeopleFemaleHumansJapanMiddle AgedRetrospective StudiesSocieties, MedicalSurveys and QuestionnairesBreast-conserving surgeryGuideline on marginsMargin assessmentRe-excision rateSurgical margin

Identifiers

PMID41949686

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