Preoperative Localization and Surgical Margins in Conservative Breast Surgery

Abstract

Breast-conserving surgery (BCS) is the treatment of choice for early breast cancer. The adequacy of surgical margins (SM) is a crucial issue for adjusting the volume of excision and for avoiding local recurrences, although the precise definition of an adequate margins width remains controversial. Moreover, other factors such as the biological behaviour of the tumor and subsequent proper systemic therapies may influence the local recurrence rate (LRR). However, a successful BCS requires preoperative localization techniques or margin assessment techniques. Carbon marking, wire-guided, biopsy clips, radio-guided, ultrasound-guided, frozen section analysis, imprint cytology, and cavity shave margins are commonly used, but from the literature review, no single technique proved to be better among the various ones. Thus, an association of two or more methods could result in a decrease in rates of involved margins. Each institute should adopt its most congenial techniques, based on the senologic equipe experience, skills, and technologies.

A prospective comparative study to evaluate the displacement of four commercially available breast biopsy markers

“…Studies have shown that clear margins are obtained in 90-92% of excisional specimens when lesions are localized using biopsy markers vs 31-62% when wire localization is used alone. 2,3 A well-known complication of marker use is the immediate displacement from the biopsied lesion. Most cases of displacement are believed to be caused by the so-called "accordion effect".…”

Radio‐guided and clip‐guided preoperative localization for malignant microcalcifications offer similar performances in breast‐conserving surgery

“…Furthermore, the US visibility of TCC allows a precise localization of the lesion, since the patient is supine with the upper limb adducted thus the breast position is the same as in the operating room. Conversely, localization methods based on mammographic guidance such as WGL, might be less accurate and more difficult because the patient need to stand in upright position, thus the breast is in a different position, and measurements between the lesion and the nipple‐areola complex or radiopaque metallic marker on the skin are required . Another advantage offered by TCC is their wide usefulness beyond surgical needs.…”

Multimodality Imaging of Charcoal Granuloma Mimicking Breast Cancer Recurrence

“…Breast-screening US has increased the detection rate of nonpalpable breast cancer, and BCS has become the treatment of choice for early breast cancer (7,8). Adequate preoperative localization is very important for the successful and minimal excision of a nonpalpable breast lesion.…”

“…Adequate preoperative localization is very important for the successful and minimal excision of a nonpalpable breast lesion. Several procedures such as wire-guided localization, radioisotope localization, dye injection (toluidine blue or methylene blue), and charcoal marking have been used to localize nonpalpable breast lesions (7)(8)(9)(10). Compared to other procedures, charcoal marking avoids the risk of displacement and can thus be used with delayed surgeries (7).…”