Breast Oncology

Annals of Surgical Oncology

, Volume 16, Issue 10, pp 2717-2730

Open Access This content is freely available online to anyone, anywhere at any time.

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

  • Rick G. PleijhuisAffiliated withDepartment of Surgery, University Medical Center GroningenDepartment of Surgery, BioOptical Imaging Center Groningen (BICG), University Medical Center Groningen
  • , Maurits GraaflandAffiliated withDepartment of Surgery, University Medical Center GroningenDepartment of Surgery, BioOptical Imaging Center Groningen (BICG), University Medical Center Groningen
  • , Jakob de VriesAffiliated withDepartment of Surgery, University Medical Center Groningen
  • , Joost BartAffiliated withDepartment of Pathology and Laboratory Medicine, University Medical Center Groningen
  • , Johannes S. de JongAffiliated withDepartment of Surgery, University Medical Center GroningenDepartment of Surgery, BioOptical Imaging Center Groningen (BICG), University Medical Center Groningen
  • , Gooitzen M. van DamAffiliated withDepartment of Surgery, University Medical Center GroningenDepartment of Surgery, BioOptical Imaging Center Groningen (BICG), University Medical Center Groningen Email author 

Abstract

Inadequate surgical margins represent a high risk for adverse clinical outcome in breast-conserving therapy (BCT) for early-stage breast cancer. The majority of studies report positive resection margins in 20% to 40% of the patients who underwent BCT. This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse affects on cosmesis, psychological distress, and health costs. In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher a priori risk for re-excision. However, most risk factors are related to tumor biology and patient characteristics, which cannot be modified as such. Therefore, efforts to reduce the number of positive margins should focus on optimizing the surgical procedure itself, because the surgeon lacks real-time intraoperative information on the presence of positive resection margins during breast-conserving surgery. This review presents the status of pre- and intraoperative modalities currently used in BCT. Furthermore, innovative intraoperative approaches, such as positron emission tomography, radioguided occult lesion localization, and near-infrared fluorescence optical imaging, are addressed, which have to prove their potential value in improving surgical outcome and reducing the need for re-excision in BCT.