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Background <p>The 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.</p> Methods <p>We 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.</p> Results <p>Overall, 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.</p> Conclusions <p>This 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.</p>

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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

  • 期刊论文

  • 发表日期：

    2026年4月8日

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  • Takehiko Sakai,
  • Yuri Kimura,
  • Makoto Ishitobi,
  • Atsushi Yoshida,
  • Yasuaki Sagara,
  • Yuka Ono,
  • Koji Takada,
  • Yuko Takahashi,
  • Takahiro Tsukioki,
  • Mao Kimoto,
  • Tomo Osako

摘要

Background

The 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.

Methods

We 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.

Results

Overall, 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.

Conclusions

This 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.