Abstract
Breast Conserving Surgery (BCS) is a rapidly emerging field increasingly adopted to facilitate breast conservation and preserve breast aesthetics. Since the publication of the Randomized Controlled Trials (RCTs) of Breast Conserving Surgery versus mastectomy in early breast cancer, the adoption of BCS for breast cancer patients’ surgical management has been comprehensive. A computerized bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. This article aims to perform a thorough review of new data regarding invasive cancer and margins while evaluating patient outcomes related to BCS after neoadjuvant chemotherapy focusing on margins, imaging evaluation, the extent of resection, and local regional recurrence outcomes. The growth pattern and biopsy of Ductal Carcinoma In Situ (DCIS) differ from invasive cancer, impacting margins. It is essential to understand how the Society of Surgical Oncology (SSO) DCIS margin guideline has influenced practice. Early breast cancer surgical management should be unique to each patient, driven by evidence-based medicine, and focused on specific clinical, histological, and molecular characteristics of the tumor. Conclusion: The current management for early breast cancer should be tailored and evidence-based to each patient based on the clinical, histological and molecular characteristics of the tumor. Presumably, the standard of care in BCS has enhanced the outcomes for this patient population. This review made by peers will help surgeons to stay up to date with the current literature and help them manage breast cancer while improving multiple clinical parameters such as Disease-Free Survival (DFS), Recurrence-Free Survival (RFS) and most importantly Overall Survival (OS).
Highlights
Mastectomy rates in the United States have been rising even though the only microscopic margin width in the Randomized Control Trials (RCTs) determining the safety of Breast Conserving Surgery (BCS) was “no ink on tumor”
This article aims to perform a thorough review of new data regarding invasive cancer and margins while evaluating patient outcomes related to BCS after neoadjuvant chemotherapy focusing on margins, imaging evaluation, the extent of resection, and local regional recurrence outcomes
This study validated that lumpectomy followed by breast irradiation was a satisfactory alternative to total mastectomy for the management of women with breast cancer, providing that the margins of the resected specimens are free of tumor (“no ink on tumor”), and a suitable cosmetic result can be obtained [1]
Summary
Mastectomy rates in the United States have been rising even though the only microscopic margin width in the Randomized Control Trials (RCTs) determining the safety of Breast Conserving Surgery (BCS) was “no ink on tumor”. Re-excision rates to obtain wider negative margins are common among surgeons due to the false belief that a wider margin is better. An example of these RCTs was the National Surgical Adjuvant Breast and Bowel Project (NSABP) B06 [1]. This study validated that lumpectomy followed by breast irradiation was a satisfactory alternative to total mastectomy for the management of women with breast cancer, providing that the margins of the resected specimens are free of tumor (“no ink on tumor”), and a suitable cosmetic result can be obtained [1]
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