Obtaining Adequate Surgical Margins in Breast-Conserving Therapy for Patients with Early-Stage Breast Cancer: Current Modalities and Future Directions

Abstract

Inadequate surgical margins represent a high risk for adverse clinical outcome in breast-conserving therapy (BCT) for early-stage breast cancer. The majority of studies report positive resection margins in 20% to 40% of the patients who underwent BCT. This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse affects on cosmesis, psychological distress, and health costs. In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher a priori risk for re-excision. However, most risk factors are related to tumor biology and patient characteristics, which cannot be modified as such. Therefore, efforts to reduce the number of positive margins should focus on optimizing the surgical procedure itself, because the surgeon lacks real-time intraoperative information on the presence of positive resection margins during breast-conserving surgery. This review presents the status of pre- and intraoperative modalities currently used in BCT. Furthermore, innovative intraoperative approaches, such as positron emission tomography, radioguided occult lesion localization, and near-infrared fluorescence optical imaging, are addressed, which have to prove their potential value in improving surgical outcome and reducing the need for re-excision in BCT.

Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound – Feasibility and surgeons’ learning curve

“…[5,[15][16][17] Therefore, US-guided surgery seems promising for obtaining adequate, clear resection margins.…”

“…[5] Other studies have also reported a high incidence of positive margins after initial excision, ranging from 20 to 60%. [15][16][17] Moreover, it has been shown that many surgeons tend to overexcise volumes of normal tissue in an effort to obtain adequate margins. Actually, it was shown that the median excision volume of all palpation-guided tumour excisions is over two times to large.…”

Volume of breast tissue excised during breast-conserving surgery in patients undergoing preoperative systemic therapy

“…Some reports have demonstrated the safety of performing BCS after neoadjuvant therapy based on preoperative clinical and mammographic assessment 6,7 . Such observation reinforce the use of adjuvant radiotherapy is highly effective in controlling microscopic residual disease achieving a satisfactory local control BCS 7,25,26 .…”

The Succes Of Frozen Section To Show Surgical Margin Involvement During Breast Conservative surgery: Results In 39 Cases

“…Bunun amacı yeterli yerel kontrol sağlayarak hastalıksız yaşam oranını istenen düzeyde tutabilmektir (1)(2)(3)(4)(5).…”

“…Ancak bu yöntemle %20-40 olguda spesimenin cerrahi sınırında tümör hücreleri saptanmakta ve bu olgularda reoperasyon gerekmektedir (3,5). Klasik yöntem hatırı sayılır bir cerrahi sınır tutulum oranı yanında, olguların yarıdan çoğunda (%55) gereksiz doku çıkarılmasına da yol açmaktadır (8).…”