Local-Regional Evaluation and Therapy: Maximizing Margin-Negative Breast Cancer Resection Rates on the First Try

Abstract

Numerous strategies and technologies have been historically used, with new ones being rapidly introduced, to maximize the chance of obtaining clear margins at the first lumpectomy. The goal of this review was to summarize the data on each, illustrate their strengths and weaknesses, and equip the surgeon to determine which best fits into their center or practice. There is no technology or device currently that always results in negative margins. Many of the studies reviewed (including frozen sections, shave margins, specimen radiography, intraoperative ultrasound, imprint cytology, and new devices) show excellent negative margin rates, but many of the comparison studies have conflicting results and reasons for this are discussed. Newer emerging technologies hold great promise but there is a tendency to overinflate positive results. It is important for surgeons to review their own re-excision rates to determine the need for further technology and strategies. Most of the investigative technologies are still years away from widespread acceptance.