Optimizing Clinical Management of Surgical Margins in Breast-Conserving Therapy for Breast Cancer

2013 ◽  
pp. 66-71
Author(s):  
Stephen R. Grobmyer ◽  
Michael S. Cowher ◽  
Joseph P. Crowe
Keyword(s):  
Breast Cancer ◽  
Retrospective Studies ◽  
Tumor Biology ◽  
Surgical Margin ◽  
Breast Conserving Therapy ◽  
Surgical Margins ◽  
Margin Assessment ◽  
Margin Width ◽  
Definition Of ◽  
Made In

There has been, and continues to be, significant controversy over the definition of an “optimal” surgical margin in breast-conserving therapy (BCT). The historic basis of this controversy stems from the original trials documenting the safety of BCT and many conflicting retrospective studies that have sought to define the association between surgical margin width and outcomes over the last 20 years. It is important to understand that margin assessment is an inexact science, and current laboratory approaches to surgical-margin assessment represent only a sampling of the surgical margin. Currently available evidence suggests that decisions regarding surgical margins in BCT should be made in the context of what is known about the biology of breast cancer, as well the interactions of tumor biology, adjuvant treatment for breast cancer, and outcomes. Achieving consensus on management of surgical margins in BCT should be a clinical priority as it offers the opportunity to reduce the burden of breast cancer treatment on patients without compromising cancer-related outcomes.

scholarly journals A study of margin width and local recurrence in breast conserving therapy for invasive breast cancer

2016 ◽  
Vol 42 (5) ◽  
pp. 657-664 ◽  
Author(s):  
J.M. Dixon ◽  
J. Thomas ◽  
G.R. Kerr ◽  
L.J. Williams ◽  
C. Dodds ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Invasive Breast Cancer ◽  
Breast Conserving Therapy ◽  
Margin Width

scholarly journals Preoperative Localization and Surgical Margins in Conservative Breast Surgery

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
F. Corsi ◽  
L. Sorrentino ◽  
D. Bossi ◽  
A. Sartani ◽  
D. Foschi
Keyword(s):  
Frozen Section ◽  
Breast Conserving Surgery ◽  
Surgical Margins ◽  
Preoperative Localization ◽  
Margin Assessment ◽  
Biological Behaviour ◽  
Frozen Section Analysis ◽  
Assessment Techniques ◽  
Definition Of ◽  
Single Technique

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.

scholarly journals Clinical efficacy of intraoperative ultrasound for margin assessment in breast conserving surgery

2020 ◽  
Author(s):  
Jeeyeon Lee ◽  
Ho Yong Park ◽  
Wan Wook Kim ◽  
Chan Sub Park ◽  
Yungeun Ji ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Resection Margin ◽  
Frozen Section ◽  
Intraoperative Ultrasound ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Assessment ◽  
Clinicopathologic Characteristics ◽  
Tumor Margin ◽  
The Mean

Abstract Background: Surgical margin negativity is highly related to local recurrence of breast cancer. The authors performed this study to evaluate if specimen mammography or ultrasonography can replace the frozen section procedure for surgical margins. Methods: One-hundred fifty five patients with breast cancer were included in this study. After the surgery, the frozen biopsies were assessed in more than three different directions, and all specimens were analyzed with mammography and ultrasonography. The clinicopathologic characteristics of the patients were assessed, and closest tumor margin–resection margin distance (TM–RM distance) to the tumor was compared among specimen mammography, ultrasonography, and pathology. Results: On comparing initial cases of positive and negative margins, the mean closest TM–RM distance in specimen ultrasonography and final pathologic reports was statistically different between both groups (DCIS: p < 0.001, p = 0.006; IDC: p = 0.042, p = 0.022). Conclusion: When the closest TM–RM distance is less than 1.8 mm in specimen ultrasonography, the frozen section cannot be waived because of high risk of margin positivity. However, if the closest TM–RM distance is >4 mm in specimen ultrasonography, the frozen section can be omitted carefully because of the very low risk of margin positivity.

scholarly journals Effect of LigaSure™, Monopolar Cautery, and Bipolar Cautery on Surgical Margins in Breast-Conserving Surgery

Breast Care ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 194-199 ◽  
Author(s):  
Ahmet Türkan ◽  
Gökhan Akkurt ◽  
Metin Yalaza ◽  
Gürkan Değirmencioğlu ◽  
Mehmet Tolga Kafadar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Thermal Damage ◽  
False Negative ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Surgical Margins ◽  
Bipolar Cautery ◽  
Tissue Sections ◽  
Significant Difference ◽  
Lumpectomy Specimen

Background: We compared the differences in thermal damage at the surgical margin between monopolar cautery, bipolar cautery, and LigaSure™ in breast cancer lumpectomy specimens and assessed the effect of these techniques on the evaluation of the surgical margins. Methods: 30 patients scheduled for breast-conserving surgery for breast cancer were included in this study. During lumpectomy, each of the superior, inferior, lateral, and medial borders of the tumour was excised using one of the following: a scalpel, monopolar cautery, bipolar cautery, and LigaSure technology. The surgical margins of frozen and paraffin-embedded tissue sections of the lumpectomy specimen were evaluated. Thermal damage was defined as the maximum depth of thermal damage (in mm) from the surgical margin, and the level was categorized as none, low (≤1 mm), or high (>1 mm). Results: There was no statistically significant difference between monopolar cautery, bipolar cautery, and LigaSure in terms of thermal damage. There was no thermal damage at the surgical margin in tissues dissected by scalpel. Conclusion: Thermal damage due to the excision method may cause false-negative and false-positive results in the surgical margin evaluation of lumpectomy specimens. More research is needed on the effects of different energy modalities on surgical margin evaluation in breast-conserving surgery.

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

2009 ◽  
Vol 16 (10) ◽  
pp. 2717-2730 ◽  
Author(s):  
Rick G. Pleijhuis ◽  
Maurits Graafland ◽  
Jakob de Vries ◽  
Joost Bart ◽  
Johannes S. de Jong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Breast Conserving Therapy ◽  
Surgical Margins ◽  
Early Stage Breast Cancer ◽  
Future Directions

scholarly journals Does Surgical Margin Width Remain a Challenge for Triple-Negative Breast Cancer? A Retrospective Analysis

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 203
Author(s):  
Eduard-Alexandru Bonci ◽  
Ștefan Țîțu ◽  
Alexandru Marius Petrușan ◽  
Claudiu Hossu ◽  
Vlad Alexandru Gâta ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Surgical Margin ◽  
Final Analysis ◽  
Breast Conserving Surgery ◽  
Breast Radiotherapy ◽  
Margin Width ◽  
Whole Breast Radiotherapy ◽  
The Impact

Background and Objectives: Local and distant relapse (LR, DR) in breast cancer vary according to its molecular subtypes, with triple-negative breast cancer (TNBC) being the most aggressive. The surgical resection margin width (SRMW) for breast-conserving surgery (BCS) has been intensely debated, especially for the aforementioned subtype. The aim of this study was to examine the impact of SRMW on LR following BCS in TNBC patients. Materials and Methods: We conducted a retrospective study including all patients with TNBC for whom BCS was performed between 2005 and 2014. Results: Final analysis included a total of 92 patients, with a median tumor size of 2.5 cm (range 0–5 cm) and no distant metastasis at the time of diagnosis. A total of 87 patients had received neoadjuvant and/or adjuvant chemotherapy, and all patients had received adjuvant whole-breast radiotherapy. After a median follow-up of 110.7 months (95% CI, 95.23–126.166), there were 5 local recurrences and 8 regional/distant recurrences with an overall LR rate of 5.4%. The risk of LR and DR was similar between groups of patients with several SRMW cut-off values. Conclusions: Our study supports a safe “no ink on tumor” approach for TNBC patients treated with BCS.

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