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Vol 71, No 4 (2021)
Review paper
Published online: 2021-06-17
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A review of methods of intraoperative margin assessment in breast conserving surgery

Tomasz Sachańbiński1, Barbara Radecka23
DOI: 10.5603/NJO.a2021.0040
·
Nowotwory. Journal of Oncology 2021;71(4):225-231.
Affiliations
  1. Oncological Surgery Department with a Sub-department of Breast Diseases, Tadeusz Koszarowski Oncology Centre in Opole, Opole, Poland
  2. Institute of Medical Sciences, Faculty of Medicine, University of Opole, Opole, Poland
  3. Clinical Oncology Department with an Outpatient Unit, Tadeusz Koszarowski Oncology Centre in Opole, Opole, Poland

open access

Vol 71, No 4 (2021)
Review article
Published online: 2021-06-17

Abstract

Breast conserving therapy is the primary treatment modality in early-stage breast cancer patients. Despite the development of methods for the intraoperative assessment of tumor margins, 20–30% of patients still require re-resection due to postoperative tumor infiltration at the surgery margins. In recent years, many methods have been developed to reduce the number of re-resections due to margin infiltration. Here we review the current methods together with several more techniques under investigation.

Abstract

Breast conserving therapy is the primary treatment modality in early-stage breast cancer patients. Despite the development of methods for the intraoperative assessment of tumor margins, 20–30% of patients still require re-resection due to postoperative tumor infiltration at the surgery margins. In recent years, many methods have been developed to reduce the number of re-resections due to margin infiltration. Here we review the current methods together with several more techniques under investigation.

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Keywords

breast conserving surgery; surgical margin; re-resection

About this article
Title

A review of methods of intraoperative margin assessment in breast conserving surgery

Journal

Nowotwory. Journal of Oncology

Issue

Vol 71, No 4 (2021)

Article type

Review paper

Pages

225-231

Published online

2021-06-17

Page views

777

Article views/downloads

738

DOI

10.5603/NJO.a2021.0040

Bibliographic record

Nowotwory. Journal of Oncology 2021;71(4):225-231.

Keywords

breast conserving surgery
surgical margin
re-resection

Authors

Tomasz Sachańbiński
Barbara Radecka

References (49)
  1. Jeziorski A, Rutkowski P, Wysocki W. Chirurgia onkologiczna t. 2. PZWL, Warszawa 2018: 820–821.
  2. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002; 347(16): 1227–1232.
    CrossRefPubMed
  3. Houssami N, Macaskill P, Marinovich ML, et al. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014; 21(3): 717–730.
    CrossRefPubMed
  4. Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014; 88(3): 553–564.
    CrossRefPubMed
  5. Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ. Ann Surg Oncol. 2016; 23(12): 3801–3810.
    CrossRefPubMed
  6. Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology, American Society for Radiation Oncology. Surgical margins in lumpectomy for breast cancer--bigger is not better. N Engl J Med. 2012; 367(1): 79–82.
    CrossRefPubMed
  7. Bolger JC, Solon JG, Khan SA, et al. A comparison of intra-operative margin management techniques in breast-conserving surgery: a standardised approach reduces the likelihood of residual disease without increasing operative time. Breast Cancer. 2015; 22(3): 262–268.
    CrossRefPubMed
  8. Dillon MF, Mc Dermott EW, O'Doherty A, et al. Factors affecting successful breast conservation for ductal carcinoma in situ. Ann Surg Oncol. 2007; 14(5): 1618–1628.
    CrossRefPubMed
  9. Dunne C, Burke JP, Morrow M, et al. Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol. 2009; 27(10): 1615–1620.
    CrossRefPubMed
  10. Balch G, Mithani S, Simpson J, et al. Accuracy of Intraoperative Gross Examination of Surgical Margin Status in Women Undergoing Partial Mastectomy for Breast Malignancy. The American Surgeon. 2005; 71(1): 22–28.
    CrossRef
  11. Chagpar AB, Killelea BK, Tsangaris TN, et al. A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer. N Engl J Med. 2015; 373(6): 503–510.
    CrossRefPubMed
  12. Wang Ke, Ren Yu, He J. Cavity Shaving plus Lumpectomy versus Lumpectomy Alone for Patients with Breast Cancer Undergoing Breast-Conserving Surgery: A Systematic Review and Meta-Analysis. PLoS One. 2017; 12(1): e0168705.
    CrossRefPubMed
  13. CLEMENT Z. Should cavity shave margins be performed as a routine in breast conserving surgery? A review of randomised controlled trials. Int J Surg Med. 2017; 3(2): 1.
    CrossRef
  14. Tang R, Coopey SB, Buckley JM, et al. Lumpectomy cavity shaved margins do not impact re-excision rates in breast cancer patients. Ann Surg Oncol. 2011; 18(11): 3036–3040.
    CrossRefPubMed
  15. Esbona K, Li Z, Wilke LG. Intraoperative imprint cytology and frozen section pathology for margin assessment in breast conservation surgery: a systematic review. Ann Surg Oncol. 2012; 19(10): 3236–3245.
    CrossRefPubMed
  16. Nowikiewicz T, Śrutek E, Głowacka-Mrotek I, et al. Clinical outcomes of an intraoperative surgical margin assessment using the fresh frozen section method in patients with invasive breast cancer undergoing breast-conserving surgery - a single center analysis. Sci Rep. 2019; 9(1): 13441.
    CrossRefPubMed
  17. Riedl O, Fitzal F, Mader N, et al. Intraoperative frozen section analysis for breast-conserving therapy in 1016 patients with breast cancer. Eur J Surg Oncol. 2009; 35(3): 264–270.
    CrossRefPubMed
  18. Martin DT, Sandoval S, Ta CN, et al. Quantitative automated image analysis system with automated debris filtering for the detection of breast carcinoma cells. Acta Cytol. 2011; 55(3): 271–280.
    CrossRefPubMed
  19. Nowecki ZJ, Jeziorski A. Chirurgiczne leczenie zmian nowotworowych piersi Konsensus Polskiego Towarzystwa Chirurgii Onkologicznej. Onkol W Prakt Klin - Eduk. 2017; 3(3): 93–153.
  20. Layfield DM, May DJ, Cutress RI, et al. The effect of introducing an in-theatre intra-operative specimen radiography (IOSR) system on the management of palpable breast cancer within a single unit. Breast. 2012; 21(4): 459–463.
    CrossRefPubMed
  21. Bimston DN, Bebb GG, Wagman LD. Is specimen mammography beneficial? Arch Surg. 2000; 135(9): 1083–6; discussion 1086.
    CrossRefPubMed
  22. Britton PD, Sonoda LI, Yamamoto AK, et al. Breast surgical specimen radiographs: how reliable are they? Eur J Radiol. 2011; 79(2): 245–249.
    CrossRefPubMed
  23. McCormick JT, Keleher AJ, Tikhomirov VB, et al. Analysis of the use of specimen mammography in breast conservation therapy. Am J Surg. 2004; 188(4): 433–436.
    CrossRefPubMed
  24. Schulz-Wendtland R, Dilbat G, Bani MR, et al. Use of Tomosynthesis in Intraoperative Digital Specimen Radiography - Is a Reduction of Breast Re-excision Rates Possible? Geburtshilfe Frauenheilkd. 2011; 71(12): 1080–1084.
    CrossRefPubMed
  25. Amer HA, Schmitzberger F, Ingold-Heppner B, et al. Digital breast tomosynthesis versus full-field digital mammography-Which modality provides more accurate prediction of margin status in specimen radiography? Eur J Radiol. 2017; 93: 258–264.
    CrossRefPubMed
  26. Chand JT, Sharma MM, Dharmarajan JP, et al. Digital Breast Tomosynthesis as a Tool in Confirming Negative Surgical Margins in Non-palpable Breast Lesions. Indian J Surg Oncol. 2019; 10(4): 624–628.
    CrossRefPubMed
  27. Karanlik H, Ozgur I, Sahin D, et al. Intraoperative ultrasound reduces the need for re-excision in breast-conserving surgery. World J Surg Oncol. 2015; 13: 321.
    CrossRefPubMed
  28. Ramos M, Díaz JC, Ramos T, et al. Ultrasound-guided excision combined with intraoperative assessment of gross macroscopic margins decreases the rate of reoperations for non-palpable invasive breast cancer. Breast. 2013; 22(4): 520–524.
    CrossRefPubMed
  29. Mesurolle B, El-Khoury M, Hori D, et al. Sonography of postexcision specimens of nonpalpable breast lesions: value, limitations, and description of a method. AJR Am J Roentgenol. 2006; 186(4): 1014–1024.
    CrossRefPubMed
  30. Qiu SQ, Dorrius MD, de Jongh SJ, et al. Micro-computed tomography (micro-CT) for intraoperative surgical margin assessment of breast cancer: A feasibility study in breast conserving surgery. Eur J Surg Oncol. 2018; 44(11): 1708–1713.
    CrossRefPubMed
  31. McClatchy DM, Zuurbier RA, Wells WA, et al. Micro-computed tomography enables rapid surgical margin assessment during breast conserving surgery (BCS): correlation of whole BCS micro-CT readings to final histopathology. Breast Cancer Res Treat. 2018; 172(3): 587–595.
    CrossRefPubMed
  32. Papa M, Allweis T, Karni T, et al. An intraoperative MRI system for margin assessment in breast conserving surgery: Initial results from a novel technique. J Surg Oncol. 2016; 114(1): 22–26.
    CrossRefPubMed
  33. Dashevsky BZ, D'Alfonso T, Sutton EJ, et al. The Potential of High Resolution Magnetic Resonance Microscopy in the Pathologic Analysis of Resected Breast and Lymph Tissue. Sci Rep. 2015; 5: 17435.
    CrossRefPubMed
  34. Thill M. MarginProbe: intraoperative margin assessment during breast conserving surgery by using radiofrequency spectroscopy. Expert Rev Med Devices. 2013; 10(3): 301–315.
    CrossRefPubMed
  35. Schnabel F, Boolbol SK, Gittleman M, et al. A randomized prospective study of lumpectomy margin assessment with use of MarginProbe in patients with nonpalpable breast malignancies. Ann Surg Oncol. 2014; 21(5): 1589–1595.
    CrossRefPubMed
  36. Dixon JM, Renshaw L, Young O, et al. Intra-operative assessment of excised breast tumour margins using ClearEdge imaging device. Eur J Surg Oncol. 2016; 42(12): 1834–1840.
    CrossRefPubMed
  37. Rząca M, Orzechowski K, Wolny A, et al. Chirurgia raka gruczołu piersiowego wspomagana technikami dielektrycznymi. Biuletyn PTO NOWOTWORY. 2017; 2(2): 140–147.
  38. Nguyen FT, Zysk AM, Chaney EJ, et al. Intraoperative evaluation of breast tumor margins with optical coherence tomography. Cancer Res. 2009; 69(22): 8790–8796.
    CrossRefPubMed
  39. Erickson-Bhatt SJ, Nolan RM, Shemonski ND, et al. Real-time Imaging of the Resection Bed Using a Handheld Probe to Reduce Incidence of Microscopic Positive Margins in Cancer Surgery. Cancer Res. 2015; 75(18): 3706–3712.
    CrossRefPubMed
  40. Zysk AM, Chen K, Gabrielson E, et al. Intraoperative Assessment of Final Margins with a Handheld Optical Imaging Probe During Breast-Conserving Surgery May Reduce the Reoperation Rate: Results of a Multicenter Study. Ann Surg Oncol. 2015; 22(10): 3356–3362.
    CrossRefPubMed
  41. Nyayapathi N, Xia J. Photoacoustic imaging of breast cancer: a mini review of system design and image features. J Biomed Opt. 2019; 24(12): 1–13.
    CrossRefPubMed
  42. Tummers QR, Verbeek FPR, Schaafsma BE, et al. Real-time intraoperative detection of breast cancer using near-infrared fluorescence imaging and Methylene Blue. Eur J Surg Oncol. 2014; 40(7): 850–858.
    CrossRefPubMed
  43. Lamberts LE, Koch M, de Jong JS, et al. Tumor-Specific Uptake of Fluorescent Bevacizumab-IRDye800CW Microdosing in Patients with Primary Breast Cancer: A Phase I Feasibility Study. Clin Cancer Res. 2017; 23(11): 2730–2741.
    CrossRefPubMed
  44. Xie W, Chen Ye, Wang Yu, et al. Microscopy with ultraviolet surface excitation for wide-area pathology of breast surgical margins. J Biomed Opt. 2019; 24(2): 1–11.
    CrossRefPubMed
  45. Goh Y, Balasundaram G, Moothanchery M, et al. Ultrasound Guided Optoacoustic Tomography in Assessment of Tumor Margins for Lumpectomies. Transl Oncol. 2020; 13(2): 254–261.
    CrossRefPubMed
  46. St John ER, Balog J, McKenzie JS, et al. Rapid evaporative ionisation mass spectrometry of electrosurgical vapours for the identification of breast pathology: towards an intelligent knife for breast cancer surgery. Breast Cancer Res. 2017; 19(1): 59.
    CrossRefPubMed
  47. John ESt, Rossi M, Balog J, et al. Real time intraoperative classification of breast tissue with the intelligent knife. Eur J Surg Oncol. 2016; 42(5): S25.
    CrossRef
  48. Hall NC, Povoski SP, Murrey DA, et al. Combined approach of perioperative 18F-FDG PET/CT imaging and intraoperative 18F-FDG handheld gamma probe detection for tumor localization and verification of complete tumor resection in breast cancer. World J Surg Oncol. 2007; 5: 143.
    CrossRefPubMed
  49. Dixon JM, Newlands C, Dodds C, et al. Association between underestimation of tumour size by imaging and incomplete excision in breast-conserving surgery for breast cancer. Br J Surg. 2016; 103(7): 830–838.
    CrossRefPubMed

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