Synopsis
Interpret radial margin reports by invasive and in-situ pathology, apply current NICE thresholds, and make re-excision decisions that balance local control, radiotherapy and breast preservation.
- A margin is the relationship between tumour and the inked specimen surface, not the surgeon’s visual impression of the cavity. Orientation lets pathology identify the involved direction.
- After breast-conserving surgery, NICE says offer further surgery when invasive cancer or DCIS is on ink at a radial margin, meaning 0 mm.
- For invasive cancer with or without DCIS, consider further surgery when tumour is more than 0 mm but less than 1 mm from a radial margin.
Investigation priorities
Measure invasive and DCIS distances to each inked radial surface and identify tumour at ink.
Management branches
After conservation for a 19 mm invasive cancer, pathology reports invasive tumour on the medial radial ink and the specimen is clearly orientated.
- In this illustrative case, the pathologist confirms that the medial radial surface contains invasive tumour at ink, not merely a close margin. There is no separately submitted clear cavity shave that would change the final margin. The oriented specimen and preoperative images localise the residual concern to the medial cavity.
- The surgeon explains that NICE recommends offering further surgery for invasive cancer or DCIS at a 0 mm radial margin, so this invasive on-ink result requires that offer. Imaging shows a focal remaining concern and adequate breast tissue for another directed excision. The patient compares re-excision with completion mastectomy, including cosmetic cost, possible further surgery and the adjuvant-treatment plan, and chooses medial re-excision.