ASO Author Reflections: Margin Analysis and Breast-Conserving Surgery

Excerpt

Positive lumpectomy margins in breast-conserving surgery (BCS) increase the risk for local recurrence and are an indication for reoperation in breast cancer patients.1 Re-excision procedures may delay the initiation of other cancer treatments and increase costs to the healthcare system.1 In addition, a return to the operating room to remove additional tissue not only exposes the patient to the risks of a second surgery but also increases the likelihood of a poor cosmetic outcome. There are multiple factors that have been proposed to increase the risk of a positive margin, including tumor size, proportion of ductal carcinoma in situ in the specimen, multifocal disease, increased tissue density, and lobular histology.2,3 Previous approaches to intraoperative margin management include shaved margins of all six surfaces of the lumpectomy cavity, intraoperative pathology consultation, and selective margin excision based on intraoperative specimen x-ray and surgeon judgment. Despite these approaches, positive margins affect at least 20–30% of patients undergoing breast conservation.4 …