Review of Current Accepted Practices in Identification of the Breast Lumpectomy Tumor Bed

Abstract

Of the 260,000 women diagnosed with breast cancer annually in the United States, more than 60% are treated with breastconserving surgery or lumpectomy, followed by radiation to decrease the chance of local recurrence. More than 70% of breast cancer recurrences are localized to the original tumor cavity. Hence, targeted radiation therapy after lumpectomy is critical for recurrence prevention. With 30,000 patients annually opting for oncoplastic reconstruction of the breast after lumpectomy to improve cosmesis, the resulting tissue rearrangement increases the difficulty for radiation oncologists to accurately delineate the cavity when planning radiation therapy. Owing to the absence of a standardized protocol, it is important to assess the efficacy of various methods used to mark the tumor cavity for improved delineation. Methods and Materials: A keyword search and analysis was used to compile relevant articles on PubMed (National Center for Biotechnology Information). Results: Currently, a common practice for tumor cavity localization is applying titanium surgical clips to the borders of lumpectomy cavity. Tissue movement and seroma formation both impact the positioning of surgical clips within the tumor cavity and lead to significant interobserver variability. Furthermore, the main application of surgical clips is to control the small vessels during surgery, and that can create confusion when the same clips are used for tumor bed localization. All alternative solutions present more precise tumor bed delineation but possess individual concerns with workflow integration, patient comfort, and accuracy. Though liquid-based fiducials were found to be the most effective for delineating tumor cavities, there are still drawbacks for clinical use. Conclusions: These findings should encourage medical innovators to develop novel techniques for tumor cavity marking to increase delineation accuracy and effectively target at-risk tissue. Future solutions in this space should consider the properties of liquid-based fiducial markers to improve radiation oncologists' ability to precisely delineate the tumor cavity.

Evolution of breast conserving surgery—current implementation of oncoplastic techniques in breast conserving surgery: a literature review

“…In a retrospective study where 649 patients underwent oncoplastic Wise pattern reduction, 95% were successfully managed with margin re-excision while maintaining breast-conserving therapy. There was only one in-breast recurrence in this case series ( 32 ). The use of magnetic resonance imaging (MRI), which enhances lesion detection sensitivity, could potentially increase the mastectomy rate.…”

Feasibility of In Vivo Metal Artifact Reduction in Contrast-Enhanced Dedicated Spiral Breast Computed Tomography

“…In the presence of metallic markers, beam hardening artifacts can overlap with breast pathologies and may prevent an accurate diagnosis. However, makers cannot be avoided, as they are inevitable for tracking biopsy locations and the tumor bed [4,26]. This study is the first to address MAR in SBCT.…”