Abstract
Background: Achieving clear surgical margins is critical in breast-conserving surgery (BCS) to minimize recurrence risk and reduce reoperation rates. Intraoperative imaging techniques provide real-time margin assessment, allowing surgeons to improve surgical precision and outcomes. Objectives: The aim and objectives of this study were to determine the effect of intraoperative imaging on margin clearance, reoperation rates, recurrence as well as the effect of key biomarkers influencing breast cancer including estrogen receptor (ER), progesterone receptor (PR), HER2, Ki67. Methods: 300 patients were divided into two groups, Group-A intraoperative imaging was done in 150 subjects while in Group-B was not done for 150 subjects. The correlation with surgical outcomes (margin status, reoperation rate, and recurrence rate), the biomarker analyzed were expression (ER, PR, HER2, Ki67). Logistic regression, Kaplan-Meier survival analysis whereas p values was performed by using 95% confidence interval (CI). Results: Intraoperative imaging was associated with significantly lower rates of positive margins (15% vs. 25%, p = 0.03), particularly in ER positive and Ki67 low tumors. Both imaging and reoperation rates were reduced (12% vs. 22%, p = 0.02) in the imaging group, in particular for ER positive patients. Reoperation rates were higher in patients with high Ki67 expression (p = 0.01) and recurrence rates were higher in patients with high Ki67 expression (p = 0.03). Kaplan-Meier analysis showed better recurrence-free survival in the imaging group, especially in ER-positive patients (HR: 0.55, p = 0.02). Conclusion: The intraoperative imaging improves margin clearance and reduces reoperation and recurrence for biologically less aggressive tumors (ER positive, low Ki67). Nevertheless, additional therapeutic strategies may be necessary for patients in high-risk subgroups, such as HER2 positive and high Ki67 tumors, to achieve optimal outcomes.
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