Intraoperative Margin Trials in Breast Cancer

Abstract

Purpose of Review Obtaining negative margins in breast conservation surgery continues to be a challenge. Re-excisions are difficult for patients and expensive for the health systems. This paper reviews the literature on current strategies and intraoperative clinical trials to reduce positive margin rates. Recent Findings The best available data demonstrate that intraoperative imaging with ultrasound, intraoperative pathologic assessment such as frozen section, and cavity margins have been the most successful intraoperative strategies to reduce positive margins. Emerging technologies such as optical coherence tomography and fluorescent imaging need further study but may be important adjuncts. Summary There are several proven strategies to reduce positive margin rates to < 10%. Surgeons should utilize best available resources within their institutions to produce the best outcomes for their patients.

Guidance in breast-conserving surgery: tumour localizationversusidentification

“…A variety of alternative localization techniques have been developed to address these flaws. Radio-occult lesion localization (ROLL) comprises injection of a radioactive colloid into the tumour, whereas a radioactive seed is implanted in radioactive seed localization (RSL) 2 , 3 , 7 , 8 . A Cochrane Review 7 confirmed that WGL is comparable to RSL and ROLL in terms of positive margins and reoperation rates, but the latter are associated with improved patient comfort, hospital flow, or surgical precision.…”

“…A Cochrane Review 7 confirmed that WGL is comparable to RSL and ROLL in terms of positive margins and reoperation rates, but the latter are associated with improved patient comfort, hospital flow, or surgical precision. More recently, a ferromagnetic seed (Magseed ® ; Endomag, Cambridge, UK), a reflector to electromagnetic radar signals (SAVI SCOUT ® ; Meritmedical, South Jordan, UT, USA), a radiofrequency tag (Localizer™; Hologic, Marlborough, MA, USA), and an electromagnetic signature for triangulation (Elucent Smart Clip™; Elucent Medical, Eden Prairie, MN, USA; NCT04604561) have entered the market 2 , 3 , 8–10 . Seldom used techniques include cryo-assisted localization (freezing) and carbon track localization (intralesional carbon injection), which enable tactile and visual feedback, respectively 8 .…”

“…There is an urgent need for techniques that can identify, on a macroscopic scale, tumour location, size, and invasiveness, thus demarcating where disease stops and healthy breast starts. Potential imaging solutions include IOUS, iMRI or FGS 3–5 . IOUS is highly operator-dependent and iMRI (preoperative MRI and intraoperative optical imaging) requires the patient to be in the same position as during the preoperative scan.…”

Fluorescence guided surgery imaging systems for breast cancer identification: a systematic review

“…There is an overwhelming need to improve precision during BCS, 10 , 44 – 47 but current localizing techniques are unable to provide surgeons with sufficient information to guarantee entire tumor removal. 12 Eliminating the need for a second surgery would benefit patients, alleviating psychological stress, reducing complications, and improving cosmetic outcomes and quality of life.…”

Optical Emission Spectroscopy for the Real-Time Identification of Malignant Breast Tissue

“…Several new approaches for intraoperative tumor margin detection have been proposed during the recent years [19,20]. A new real-time in situ tissue differentiation method is optical emission spectroscopy (OES) [21][22][23].…”