The importance of surgical margins in breast cancer

Abstract

Achieving negative margins with "no tumor on ink" is an appropriate goal in breast conserving therapy (BCT). Wider margins do not decrease recurrence rates, and re-excision in patients with microscopic positive margins is warranted. Several strategies exist to increase rates of negative margins, including techniques to improve tumor localization, intraoperative assessment of margins and oncoplastic techniques. Negative margins should be the goal of BCT, as this will improve both local control and long-term survival.

Feasibility Study of a Novel Protease-Activated Fluorescent Imaging System for Real-Time, Intraoperative Detection of Residual Breast Cancer in Breast Conserving Surgery

“…5,[10][11][12][13][14][15] Both standard and experimental specimen-based approaches for margin assessment suffer from challenges related to specimen deformation that make orientation unreliable, trauma to specimen surfaces that results in false positive margins, and the inability to assess more than a small fraction of a specimen surface. [16][17][18] The ideal approach for intraoperative margin assessment for cancer surgery would rapidly identify residual tumor directly in the walls of the surgical cavity, guide additional excision, and verify that clear margins have been achieved. The LUM Imaging System is a cavity-based margin assessment tool that addresses these margin assessment goals.…”

Current possibilities of peri-operative evaluation of the radicality of primary tumour resection in breast cancer patients treated with BCT (breast conserving treatment)

“…They concern, first of all, a lower sensitivity of the examination (65-78%). Moreover, such an evaluation extends the overall operative time [17][18][19].…”

Changes in margin re‐excision rates: Experience incorporating the “no ink on tumor” guideline into practice

“…The Milan trials required a quadrantectomy with 2‐3 cm of grossly normal margins including skin and fascia . Over the last 30‐40 years, surgeons have used anywhere from 1‐10 mm with 2 mm as the most commonly accepted margin width based on surgeon preference, institutional polices, and histopathology . Although multifactorial, varied margin definitions contribute to 15‐50% of patients returning to the operating room for a margin re‐excision .…”

“…[2][3][4] Over the last 30-40 years, surgeons have used anywhere from 1-10 mm with 2 mm as the most commonly accepted margin width based on surgeon preference, institutional polices, and histopathology. 5 Although multifactorial, varied margin definitions contribute to 15-50% of patients returning to the operating room for a margin re-excision. [6][7][8][9] In 2014, the Society of Surgical Oncology and American Society for Radiation Oncology consensus guidelines were released suggesting the appropriate margin width as "no ink on tumor" in patients with stages I and II invasive breast cancer undergoing breast conserving therapy with whole breast radiation.…”