Perioperative measures to optimize margin clearance in breast conserving surgery

Fernando A. Angarita, Ashlie Nadler, Siham Zerhouni, Jaime Escallon

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)81-91
Number of pages11
JournalSurgical Oncology
Volume23
Issue number2
DOIs
StatePublished - Jun 2014

Keywords

  • Breast cancer
  • Breast conserving surgery
  • Ductal carcinoma in situ
  • Invasive ductal carcinoma
  • Margin
  • Margin clearance
  • Margin status
  • Perioperative tools

ASJC Scopus subject areas

  • Surgery
  • Oncology

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