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International Journal of Surgical Oncology
Volume 2012, Article ID 585670, 9 pages
http://dx.doi.org/10.1155/2012/585670
Review Article

Optimizing Surgical Margins in Breast Conservation

1Breast Surgery Division, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
2Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA

Received 2 October 2012; Accepted 31 October 2012

Academic Editor: Eisuke Fukuma

Copyright © 2012 Preya Ananthakrishnan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Adequate surgical margins in breast-conserving surgery for breast cancer have traditionally been viewed as a predictor of local recurrence rates. There is still no consensus on what constitutes an adequate surgical margin, however it is clear that there is a trade-off between widely clear margins and acceptable cosmesis. Preoperative approaches to plan extent of resection with appropriate margins (in the setting of surgery first as well as after neoadjuvant chemotherapy,) include mammography, US, and MRI. Improvements have been made in preoperative lesion localization strategies for surgery, as well as intraoperative specimen assessment, in order to ensure complete removal of imaging findings and facilitate margin clearance. Intraoperative strategies to accurately assess tumor and cavity margins include cavity shave techniques, as well as novel technologies for margin probes. Ablative techniques, including radiofrequency ablation as well as intraoperative radiation, may be used to extend tumor-free margins without resecting additional tissue. Oncoplastic techniques allow for wider resections while maintaining cosmesis and have acceptable local recurrence rates, however often involve surgery on the contralateral breast. As systemic therapy for breast cancer continues to improve, it is unclear what the importance of surgical margins on local control rates will be in the future.