Perioperative measures to optimize margin clearance in breast conserving surgery.
Margin status is one of the most important determinants of local recurrence following breast conserving surgery. The fact that up to 60% of patients undergoing breast conserving surgery require re-excision highlights the importance of optimizing margin clearance. In this review we summarize the following perioperative measures that aim to enhance margin clearance: (1) patient risk stratification, specifically risk factors and nomograms, (2) preoperative imaging, (3) intraoperative techniques including wire-guided localization, radioguided surgery, intraoperative ultrasound-guided resection, intraoperative specimen radiography, standardized cavity shaving, and ink-directed focal re-excision; (4) and intraoperative pathology assessment techniques, namely frozen section analysis and imprint cytology. Novel surgical techniques as well as emerging technologies are also reviewed. Effective treatment requires accurate preoperative planning, developing and implementing a consistent definition of margin clearance, and using tools that provide detailed real-time intraoperative information on margin status.
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario M5S 1A1, Canada. Electronic address: fernando.angarita@mail.utoronto.ca.
Fernando A
FA
Angarita
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario M5S 1A1, Canada. Electronic address: ashlie.nadler@mail.utoronto.ca.
Ashlie
A
Nadler
Department of Surgery, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada. Electronic address: siham.zerhouni@mail.mcgill.ca.
Siham
S
Zerhouni
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario M5S 1A1, Canada; Department of Surgical Oncology, University of Toronto, Princess Margaret Hospital, Toronto, Ontario M5T 2M9, Canada; Marvelle Koffler Breast Centre, Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada. Electronic address: JEscallon@mtsinai.on.ca.
Jaime
J
Escallon
D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D019990:Perioperative Care
Breast cancer; Breast conserving surgery; Ductal carcinoma in situ; Invasive ductal carcinoma; Margin; Margin clearance; Margin status; Perioperative tools