Intra‐operative guidance: Methods for achieving negative margins in breast conserving surgery

Abstract

The increasing incidence of breast cancer and advances in detection of small, impalpable cancers presents increasing challenges for the modern breast surgeon. Accurate localization and excision with adequate oncological margins to reduce loco-regional recurrence rates whilst minimizing volume deficit and maximizing aesthetics remains the "gold standard." We review the current techniques available and the developments within this field.

Real‐time electromagnetic navigation for breast‐conserving surgery using NaviKnife technology: A matched case‐control study

“…The current positive margin rate for BCS is approximately 30% . Accurate excision of the tumor at first attempt would reduce the need for a second or third surgery.…”

“…The presence of a positive margin is linked with higher local tumor recurrence rates despite adjuvant radiotherapy . Even with current localization methods, around a quarter of women will undergo additional surgeries to manage the positive margin …”

Positive margins prediction in breast cancer conservative surgery: Assessment of a preoperative web-based nomogram

“…Other measures include perioperative assessment of other risk factors (including young age, positive axillary lymph nodes, lymph vascular invasion status, extratumoral DCIS and lack of adjuvant therapy), intraoperative measures (such as surgeon skills, multidisciplinary team experience, ultrasound or radio guided resection, wire-guided localization, intraoperative specimen radiology and pathology assessment) and surgical techniques (for example, cavity shaving) [14,36,37]. Other novel techniques have been proposed for better preoperative planning, such as 3D specimen imaging (with a minimal 1.1% reduction of margin positivity when compared to 2D techniques) and radiofrequency ablation of positive margins [38,39].…”

Local Treatment of Breast Cancer

“…33,34 A lumpectomy is successful when the entire lesion is excised and the pathology report indicates negative margins. [33][34][35] The goal of negative margins is to use accurate localization and excision with appropriate margins to decrease the risk of local recurrence of tumor while minimizing loss of volume and maximizing aesthetics. 33,34 The exact number of millimeters required to define a clear margin (e.g., 1 to 10 mm) remains controversial, although tumor at the inked margin can occur in up to 40% of cases, which is unacceptable because of a 2-fold increase in ipsilateral recurrence.…”

“…36 Pathology results that indicate one or more positive margins require additional surgery to ensure complete removal of all cancer cells. [33][34][35][36] A re-excision of margins (e.g., relumpectomy) may be attempted for one or two positive margins, although mastectomy is indicated in the case of multiple positive margins. [33][34][35][36] Attempts to improve positive margins, including the use of intraoperative real-time ultrasound, 35,36 multiple frozen sections, 33 or non-surgical ablation, 37 continue to be studied.…”