ASO Author Reflections: Image-Guided Margin Assessment for Breast Cancer

Excerpt

Safe lumpectomy surgery for breast cancer requires complete excision of tumor to achieve microscopically tumor-free margins. Initially, excision of breast cancers was guided by palpation, with a rim of grossly normal tissue taken around the palpable mass. Breast imaging now identifies non-palpable extensions and satellites of palpable cancers, and finds small non-palpable tumors. Marker localization and intraoperative specimen mammography now guide excision of the non-palpable lesions. Some sites use intraoperative frozen section testing of margins, but this is not widely available, prolongs surgery, and examines only a tiny fraction of the lumpectomy surface. Unfortunately, using current tools, and even with an additional shaved cavity margin excision, 10–40% of lumpectomies have positive margins that require a second surgical procedure.1 When ‘clean’ margins have been obtained, radiation is still required, as local recurrence rates are as high as 40% with lumpectomy alone.2 Better tools for identifying and removing residual tumor during surgery are needed. …