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Fig. 4.5 Specimen Mammogram after resection for assessment of gross margin of a non-palpable lesion after neoadjuvant chemotherapy

D. K. Muduly and M. Kar

Fig. 4.6 Cavity Shave Margins is taken by resecting a thin strip of tissue on the lumpectomy cavity. (One each from superior, inferior, medial, lateral, and deep margins)

Table 4.1 Margin assessment

Gross margin assessment

Microscopic margin assessment

Newer technologies MarginProbe

Finger palpation Cut-section of the specimen Ultrasound Specimen mammogram Intra-operative: Frozen

section biopsy Post-operative: On parafn sections

Lumicell

Fig. 4.7 Clip placement in lumpectomy cavity

4.5.3 Oncoplastic Techniques

andWound Closure

Different oncoplastic techniques have been described and will be discussed in subsequent chapters. However, all the oncoplastic techniques obey the principles of breast conservation sur-

4 Oncologic Principles ofBreast Conservation andOncoplastic Breast Surgery

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gery, i.e., achieving a negative margin with the preservation of cosmesis of the breast. After proper hemostasis, the wound closure is always performed by sub-cuticular sutures.

4.5.4 Specimen Orientation andPathology Requisition

Post-resection, the specimen is oriented using suture, marker clips or by inking of the margins. We use a short single suture on the superior margin, long single suture on the lateral margin (Mnemonic - short superior, long lateral) and short double suture anteriorly (if required, when skin is not resected) (Fig.4.8a, b). The pathology requisition should be lled with all clinical, imaging, previous histology, neoadjuvant therapy

and surgical details mentioned. It is important to draw a diagram on the form to properly depict and orient the lesion. A good communication with the pathologist is crucial.

4.6 Conclusion

Breast conservation therapy is recommended in all suitable patients. Achieving a gross and microscopic negative margin status is the most important factor inuencing recurrence and survival. Most common technique used to get adequate gross margin intra-operatively is palpation guided resection and ultrasound-guided resection. Some centers perform frozen section analysis of cavity shave margins for microscopic margin intra- operatively. After resection, the specimen should be oriented and pathology requisition should be properly lled. Clips should be placed in the cavity for easy identication of the lumpectomy cavity for radiation planning. A sound BCS is mandatory for successful outcome of oncoplastic breast surgery.

References

1. National Comprehensive Cancer Network. 2021. Breast cancer (version 4.2021). Retrieved from

Fig. 4.8 (a) Specimen orientation with superior–short single suture, lateral–long single suture, Anterior–short double suture, (b) Specimen orientation when skin resected: with superior–short single suture, lateral–long single suture, Anterior–skin

https://www.nccn.org/professionals/physician_gls/ pdf/breast.pdf

2. Olson JA, Morris EA, Van Zee KJ, Linehan DC, Borgen PI. Magnetic resonance imaging facilitates breast conservation for occult breast cancer. Ann Surg Oncol. 2000 Jul;7(6):411–5.

3. Buchanan CL, Morris EA, Dorn PL, Borgen PI, Van Zee KJ. Utility of breast magnetic resonance imaging in patients with occult primary breast cancer. Ann Surg Oncol. 2005 Dec;12(12):1045–53.

4. Cilotti A, Iacconi C, Marini C, Moretti M, Mazzotta D, Traino C, etal. Contrast-enhanced MR imaging in patients with BI-RADS 3-5 microcalcications. Radiol Med (Torino). 2007 Mar;112(2):272–86.

5. Phan C, Mindrum M, Silverman C, Paris K, Spanos W. Matched-control retrospective study of the acute and late complications in patients with collagen vascular diseases treated with radiation therapy. Cancer J Sudbury Mass. 2003 Dec;9(6):461–6.

6. Park CC, Mitsumori M, Nixon A, Recht A, Connolly J, Gelman R, etal. Outcome at 8years after breastconserving surgery and radiation therapy for invasive breast cancer: inuence of margin status and systemic

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D. K. Muduly and M. Kar

therapy on local recurrence. J Clin Oncol Off J Am Soc Clin Oncol. 2000 Apr;18(8):1668–75.

7. Pierce LJ, Phillips K-A, Grifth KA, Buys S, Gaffney DK, Moran MS, etal. Local therapy in BRCA1 and BRCA2 mutation carriers with operable breast cancer: comparison of breast conservation and mastectomy. Breast Cancer Res Treat. 2010 Jun;121(2):389–98.

8. Jones V, Linebarger J, Perez S, Gabram S, Okoli J, Bumpers H, et al. Excising additional margins at initial Breast-Conserving Surgery (BCS) reduces the need for re-excision in a predominantly African American population: a report of a randomized pro-

spective study in a public hospital. Ann Surg Oncol. 2016 Feb;23(2):456–64.

9. Chagpar AB, Killelea BK, Tsangaris TN, Butler M, Stavris K, Li F, etal. A randomized, controlled trial of cavity shave margins in breast cancer. N Engl J Med. 2015 Aug 6;373(6):503–10.

10. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al. SSO-ASTRO consensus guideline on margins for breast-conserving surgery with whole breast irradiation in stage I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):553–64.

Margin Assessment inBreast

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Conserving Surgery

S.V.S.Deo, AshutoshMishra, ChitreshKumar, andSandeepBhoriwal

5.1 Introduction

Breast conserving therapy (BCT) results in equivalent disease-specic survival as mastectomy and has become the standard of care in early breast cancer (EBC) treatment [1–5]. Breast conservative surgery (BCS) is aimed at complete removal of breast tumor with negative surgical margins and acceptable aesthetic outcomes.

An attempt to conserve breast tissue for better cosmetic outcomes sometimes leads to positive surgical margins and subsequently results in revision surgery and almost two-fold increase in IBTR [6]. Therefore achieving “clear” or negative margins is mandatory in BCS.Reoperations are associated with increased morbidities, delay in adjuvant treatment, cost and burden on individual and health care facilities. The reported rates of re-excision vary from 10% to greater than 40% [7–11].

5.2 Denition ofNegative

Margin

The surgical margin is assessed by applying ink to the surface of the lumpectomy specimen and determining the microscopic distance between

S. V. S. Deo (*) · A. Mishra · C. Kumar S. Bhoriwal Department of Surgical Oncology, DR BRA-IRCH, AIIMS, New Delhi, India

the inked surface and tumor cells. The exact denition of a negative or optimal margin had been a matter of debate among clinicians until recently.

The 2013 Society of Surgical Oncology– American Society for Radiation Oncology (SSOASTRO) consensus guideline on margins for BCS with whole-breast irradiation in patients with stages I and II invasive breast cancer suggests that “no ink on tumor” be considered the standard for a negative margin [6]. These margin consensuses are applied for all ages and tumor of any biology.

The 2013 SSO-ASTRO consensus dened the positive margin as ink on invasive cancer or ductal carcinoma in situ (DCIS) and it is associated with at least a two-fold increase in ipsilateral breast tumor recurrence (IBTR). This increased risk cannot be nullied even after delivering RT boost dose or systemic therapy.

The recently published SSO–ASTRO– American Society of Clinical Oncology consensus guideline (2016) on margins for BCS with whole-breast irradiation in patients with ductal carcinoma in situ (DCIS) suggested that a 2mm margin be considered the standard for a negative margin in these patients. The routine practice of obtaining negative margin widths wider than 2 mm is not supported by the evidence [12]. Similarly, DCIS with microinvasion (DCIS-M), dened as no invasive focus larger than 1mm in size, should be considered DCIS when determining the optimal margin width. There are limita-

https://doi.org/10.1007/978-981-99-5536-7_5

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S. V. S. Deo et al.

tions to these guidelines for DCIS as they are recommended for BCS with WBRT and they cannot be extrapolated for APBI and DCIS with invasive carcinoma [12].

Hence, re-excision is indicated for tumor cells on inked margin and DCIS margin is less than 2 mm. In contrary, no re-excision is needed if LCIS is present on inked margin as it is a risk factor not the precursor of breast cancer.

5.3 Predictors ofPositive

Margins inBreast Conservative Surgery

In various studies, it has been reported that there are multiple factors which are responsible for margin positivity in lumpectomy specimens. These factors include:

• Extensive intraductal disease

• Multifocal disease

• Presence of mammographic microcalcica-

tions

• Non-ductal histology

• Pathologic nodal status

• Her 2 enriched

• Tumor size, presence of DCIS

• Caudal location of the lesion

• Ductal carcinoma in situ was associated with a

higher rate of positive margins at lumpectomy

than invasive breast cancer.

5.4 Preoperative Imaging

Preoperative imaging helps in evaluating the extent of disease and appropriate surgical planning that subsequently results in the achievement of optimal margins.

Conventional preoperative imaging includes bilateral mammography and ultrasound. Bilateral mammography is the most used imaging tool, and it helps in characterizing lump, extent of microcalcications, multifocality, multicentricity, and contralateral breast. In contrast to mammography, ultrasonography breast is quite helpful in the assessment of young and dense breasts.

MRI is not a modality of choice for routine assessment of breast lumps although it is reserved for special situations and as a problem-solving tool. Breast MRI on the one hand has high sensitivity for evaluation of extent of disease particularly in invasive breast cancer and dense breasts, while on the other hand it has shown more false positives and occult disease which leads to more mastectomies. Sensitivity and specicity of CE-MRI are 90–100% and 70–80%, respectively [13–16].

Two prospective RCTs have assessed the utilities of breast MRI in determining the disease extent but none of them demonstrated any improvement in post-lumpectomy re-excision rates [17, 18].

In a systematic review [19], preoperative MRI breast evaluation has documented alteration of treatment in 7.8–33.3% of women despite that no difference has been noted inlocal recurrence or survival. There is also no evidence that the pre-op breast MRI increases margin negative resection rate [20, 21]. Rather, it leads to higher patient anxiety, and more biopsies, without any evidence of benet.

5.5 Margin Assessment

forNonpalpable Breast Lesions

Most of the breast cancers diagnosed on screening mammography are not palpable. Removing these tumors with negative margins is a real challenge, and a localization technique is very helpful.

1. Wire localization: It is the oldest and standard

techniques to localize non-palpable tumors. In 1965, it was rst used by Dodd etal. In this technique, a non-palpable lesion is localized using a ne wire inserted percutaneously under either mammographic or ultrasonographic guidance [22].

The margin clearance rate associated with needle/wire localization is 54–89% [23, 24]. For patients with a wider span of calcications or a larger extent of disease, radiologists can often place more than one wire to “bracket” the area in question.

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2. Radioactive seed localization (RSL): Radioactive seed localization (RSL) has emerged as an alternative to needle localization. In 1999, Dauway and colleagues rst used this technique to localize the lesion by radioactive 125I. The radioactive seed is inserted into the breast lesion percutaneously prior to surgery under stereotactic guidance. During surgery, the lesion is localized by using a gamma- probe on the 125I setting. As it involves a radioactive seed, radiation safety protocols must be followed [25]. Also, there are some chances (<2%) of seed migration. The margin clearance rate associated with RSL is 58–96% [26].

3. Radio-occult lesion localization (ROLL): ROLL was rst introduced at European Institute of Oncology in Milan in 1996. It uses the injection of a radioactive isotope to localize non-palpable lesions. The short half-life of the isotopes requires injection the morning of surgery and that can be localized intraoperatively by gamma-probe [27]. RSL and ROLL both have the advantage of not requiring placement of a wire external to the breast and surgeon may plan their preferred incision. It is also convenient to check the residual tissue for radioactivity and thereby reduces the chance of an excision with tumor-positive

margins. The margin clearance rate associated with ROLL is 78–92% [23, 28].

4. Intraoperative ultrasound: The use of intraoperative ultrasound (IOUS) has been found to aid the localization of both palpable and ultrasonographically visible non-palpable tumors. Real time assessment and logistical simplicity are the real advantages. As it is operator dependent, hence more precision is needed. It improves margin clearance rates in comparison with palpation or needle localization alone. US-guided surgery is also hampered by the fact that US images often underestimate the size of the lesion and premalignant ductal carcinoma in situ components cannot be accurately visualized. Underestimation of the lesion can be abolished by resecting the visualized lesion with an adequate margin (0.5–1cm). The margin clearance rate associated with US-guided surgery is 78–96% [29, 30].

5. Novel localization technologies: There are few novel tools that have been developed to localize non-palpable lesions with infrared radar (e.g., Savi Scout), magnetic seeds (e.g., MAGSEED), or radiofrequency identication tags (RFID). The data on the positive margin rates of the newer tools are limited and not from randomized trials.

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S. V. S. Deo et al.

5.6 Intraoperative Margin Assessment Techniques

These techniques help in evaluating the oncological status of the resection margins during surgery, thereby facilitating immediate margin re-excision whenever required.

1. Specimen radiography: It is probably the

most utilized techniques of intraoperative margin assessment of non-palpable tumors. It can identify that the lesion along with preoperatively placed radio-opaque markers has been completely removed with clear gross margins. To guide further margin excision based on the specimen radiograph, it is critical to properly orient the specimen with at least two orthogonal markers. Intraoperative specimen radiography can be used in both nonpalpable lesions with calcications and palpable lesions visible on mammograms. Data is available in the literature pertaining to the accuracy, sensitivity, and specicity of specimen. Few previous RCTs reported a

15.7% positive margin rate and 5.7% reoperation rate [31, 32]. Several factors may affect mammographic outcomes particularly breast density. In Jin M etal. study, margin status was conrmed in 97.1% of lesions with <50% mammographic density and 85.7% of other lesions [33].

2. The role of tomosynthesis: The traditional

specimen radiography produces a twodimensional image. The orthogonal specimen radiographs or tomosynthesis permits a threedimensional view which can be helpful in intraoperative margin assessment. Digital breast tomosynthesis could detect cancer more accurately than digital mammography [34].

3. Frozen section analysis and/or touch

imprint cytology: Frozen section and/or touch imprint cytology is also the method of intraoperative evaluation of margins. The reexcision rate of FSA ranges from 3 to 10%, whereas that of imprint cytology ranges from 0 to 33%. Both are signicantly lower than that achieved without intraoperative patho-

logical assessment [35, 36]. The intraoperative pathological margin assessment is challenging because of the nonavailability of appropriately trained pathologists to render a timely evaluation of the margins intraoperatively. The second issue is that the specimen is grossly evaluated, and the areas that are the most suspicious are sampled for intraoperative assessment because it is impossible to sample the full surface area of a partial mastectomy specimen intraoperatively. For margin assessment with frozen section, there have been some issues that fatty tissue does not get properly frozen and xed, and valuable tissue may be lost in the cryostat.

4. Cavity shave margin assessment: Many of the centers especially in developing worlds do not have the facility of frozen section for margin assessment during breast conserving surgeries. And it has been proven in prospective randomized controlled trials that routine excision of a small rim of tissue circumferentially from the cavity results in a signicant reduction in the positive margin rate and re-excision rates. The cavity shave margins should be oriented to indicate their locations and surface. This technique is not associated with a signicant increase in operating time, complications, or worse cosmetic outcome.. In a randomized clinical trial by Chagpar et al., this technique reduced positive margins by nearly 50% without an apparent adverse impact on cosmesis. Therefore routine cavity shave is an very good option in resource constrained settings [37–39].

5. Novel technologies of intraoperative mar- gin assessment: There has been signicant development of devices used to predict positive margins intraoperatively. The margin probe is the oldest and widely studied device, which utilizes radio frequency spectroscopy to detect cancer cells at the edge of a specimen. The studies proved a lower positive margin rate and re-excision rate with this device. Another recent device is the Lumicell which utilizes a protease-activated uorescent probe. It is being used to evaluate the cavity after resection of a tumor to guide further resection

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of residual disease. In a few preliminary studies, this technology has been found to be associated with lower positive margin rates. The LUM015 imaging agent needs to be injected 2–6h before the surgical procedure [40].

6. Several other intraoperative margin assessment technologies are being developed [40]

• Micro-computed tomography (micro-CT)

• Optical coherence tomography (OCT)

• Nonlinear microscopy (NLM)

• ClearEdge

• Optical see-through goggle augmented imaging and navigation systems (OST GAINS)

• Cerenkov luminescence

• The intelligent knife (iKnife, Medimass, Budapest)

• Raman spectroscopy (RS)

5.7 Management Algorithm Based onMargin Status

References

1. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N.Twentyyear follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002 Oct 17;347(16):1233–41.

2. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E.Twentyyear follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002 Oct 17;347(16):1227–32.

3. Jacobson JA, Danforth DN, Cowan KH, d’Angelo T, Steinberg SM, Pierce L, Lippman ME, Lichter AS, Glatstein E, Okunieff P.Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med. 1995 Apr 6;332(14):907–11.

4. van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, van der Schueren E, Helle PA, van Zijl K, Bartelink H. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of cancer 10801 trial. J Natl Cancer Inst. 2000 July 19;92(14):1143–50.

5. Fisher B, Dignam J, Wolmark N, Mamounas E, Costantino J, Poller W, etal. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: Findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol. 1998;16:441–52.

6. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, Klimberg S, Chavez-MacGregor M, Freedman G, Houssami N, Johnson PL, Morrow M. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):553–64.

https://doi.org/10.1016/j.ijrobp.2013.11.012.

https://t.me/medicina_free

S. V. S. Deo et al.

7. Landercasper J, Whitacre E, Degnim AC, Al-Hamadani M. Reasons for re-excision after lumpectomy for breast cancer: insight from the American Society of Breast Surgeons Mastery(SM) database. Ann Surg Oncol. 2014;21(10):3185–91.

8. Rivere AE, Chiasson KF, Corsetti RL, Fuhrman GM. An assessment of margins after lumpectomy in breast cancer management. Am Surg. 2016;82(2):156–60.

9. McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in re-excision following breast conservation surgery. JAMA. 2012;307(5):467–75.

10. Sheikh F, Pockaj B, Wasif N, Dueck A, Gray RJ.Positive margins after breast-conserving therapy: localization technique or tumor biology? Am J Surg. 2011;202(3):281–5.

11. Singh M, Singh G, Hogan KT, Atkins KA, Schroen AT.The effect of intraoperative specimen inking on lumpectomy re-excision rates. World J Surg Oncol. 2010;8:4.

12. Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, et al. Society of surgical oncology–American society for radiation oncology–American society of clinical oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Pract Radiat Oncol. 2016;6(5):287–95.

https://doi.org/10.1016/j.prro.2016.06.011.

13. Menezes GL, Knuttel FM, Stehouwer BL, Pijnappel RM, van den Bosch MA.Magnetic resonance imaging in breast cancer: a literature review and future perspectives. World J Clin Oncol. 2014;5(2):61–70.

https://doi.org/10.5306/wjco.v5.i2.61.

14. Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, Ioffe OB.Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004;233:830–49. [PMID: 15486214 DOI: 10.1148/radiol.2333031484]

15. Boetes C, Mus RD, Holland R, Barentsz JO, Strijk SP, Wobbes T, Hendriks JH, Ruys SH.Breast tumors: comparative accuracy of MR imaging relative to mammography and US for demonstrating extent. Radiology. 1995;197:743–7. [PMID: 7480749]

16. Zhang Y, Ren H. Meta-analysis of diagnostic accuracy of magnetic resonance imaging and mammography for breast cancer. J Can Res Ther. 2017;13:862–8.

17. Peters NH, van Esser S, van den Bosch MA, Storm RK, Plaisier PW, van Dalen T, Diepstraten SC, Weits T, Westenend PJ, Stapper G, Fernandez-Gallardo MA, Borel Rinkes IH, van Hillegersberg R, Mali WP, Peeters PH.Preoperative MRI and surgical management in patients with nonpalpable breast cancer: the MONET – randomised controlled trial. Eur J Cancer 2011 April;47(6):879–886. doi: https://doi.

org/10.1016/j.ejca.2010.11.035. Epub 2010 Dec 30.

18. Turnbull LW, Brown SR, Olivier C, Harvey I, Brown J, Drew P, Hanby A, Manca A, Napp V, Sculpher M, Walker LG, Walker S, COMICE Trial Group.

Multicentre randomised controlled trial examining the cost-effectiveness of contrast-enhanced high eld magnetic resonance imaging in women with primary breast cancer scheduled for wide local excision (COMICE). Health Technol Assess. 2010 Jan;14(1):1–182. https://doi.org/10.3310/hta14010.

19. Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, Irwig L. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol 2008 July 1;26(19):3248–3258. doi:

https://doi.org/10.1200/JCO.2007.15.2108. Epub

2008 May 12.

20. Bleicher RJ, Ciocca RM, Egleston BL, Sesa L, Evers K, Sigurdson ER, Morrow M.Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg. 2009 Aug;209(2):180–187.; quiz 294–5. doi: https://doi.org/10.1016/j.jam-

collsurg.2009.04.010. Epub 2009 Jun 18. Erratum

in: J Am Coll Surg 2009 Nov;209(5):679. PMID: 19632594; PMCID: PMC2758058.

21. Turnbull L, Brown S, Harvey I, Olivier C, Drew P, Napp V, Hanby A, Brown J. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet. 2010 Feb 13;375(9714):563–71. https://doi.org/10.1016/

S0140- 6736(09)62070- 5.

22. Frank HA, Hall FM, Steer ML.Preoperative localization of nonpalpable breast lesions demonstrated by mammography. N Engl J Med. 1976;295(5):259–60.

https://doi.org/10.1056/nejm197607292950506.

23. Moreno M, Wiltgen JE, Bodanese B, Schmitt RL, Gutlen B, da Fonseca LM. Radioguided breast surgery for occult lesion localization – correlation between two methods. J Exp Clin Cancer Res. 2008;27:29.

24. Medina-Franco H, Abarca-Perez L, Garcia-Alvarez MN, Ulloa-Gomez JL, Romero-Trejo C, SepulvedaMendez J. Radioguided occult lesion localization (ROLL) versus wire-guided lumpectomy for nonpalpable breast lesions: a randomized prospective evaluation. J Surg Oncol. 2008;97(2):108–11.

25. Jakub JW, Gray RJ, Degnim AC, Boughey JC, Gardner M, Cox CE. Current status of radioactive seed for localization of non palpable breast lesions. Am J Surg. 2010;199(4):522–8.

26. van Riet YE, Jansen FH, van Beek M, van de Velde CJ, Rutten HJ, Nieuwenhuijzen GA.Localization of non-palpable breast cancer using a radiolabelled titanium seed. Br J Surg. 2010;97(8):1240–5.

27. Luini A, Zurrida S, Galimberti V, Paganelli G.Radioguided surgery of occult breast lesions. Eur J Cancer. 1998;34(1):204–5.

28. Monti S, Galimberti V, Triro G, et al. Occult breast lesion localization plus sentinel node biopsy (SNOLL): experience with 959 patients at the European Institute of Oncology. Ann Surg Oncol. 2007;14(10):2928–31.

5 Margin Assessment inBreast Conserving Surgery

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29. van Esser S, Stapper G, van Diest PJ, etal. Ultrasoundguided laser-induced thermal therapy for small palpable invasive breast carcinomas: a feasibility study. Ann Surg Oncol. 2009;16(8):2259–63.

30. Shoma A, Moutamed A, Ameen M, Abdelwahab A.Ultrasound for accurate measurement of invasive breast cancer tumor size. Breast J. 2006;12(3):252–6.

31. Bathla L, Harris A, Davey M, Sharma P, Silva E.High resolution intra-operative two-dimensional specimen mammography and its impact on second operation for re-excision of positive margins at nal pathology after breast conservation surgery. Am J Surg. 2011;202:387–94.

32. Allweis TM, Kaufman Z, Lelcuk S, Pappo I, Karni T, Schneebaum S, etal. A prospective, randomized, controlled, multicenter study of a real-time, intraoperative probe for positive margin detection in breastconserving surgery. Am J Surg. 2008;196:483–9.

33. Jin M, Kim JY, Kim TH, Kang DK, Han SH, Jung Y. Intraoperative specimen mammography for margin assessment in breast-conserving surgery. J Breast Cancer. 2019 Dec;22(4):635–40. https://doi.

org/10.4048/jbc.2019.22.e58.

34. Urano M, Shiraki N, Kawai T, Goto T, Endo Y, Yoshimoto N, Toyama T, Shibamoto Y. Digital mammography versus digital breast tomosynthesis for detection of breast cancer in the intraoperative

specimen during breast-conserving surgery. Breast Cancer 2016 Sep;23(5):706–711. doi: https://doi.

org/10.1007/s12282- 015- 0628- 5. Epub 2015 July 23.

35. Esbona K, Li Z, Wilke LG. Intraoperative imprint cytology and frozen section pathology for margin assessment in breast conservation surgery: a systematic review. Ann Surg Oncol. 2012;19:3236–45.

36. Osborn JB, Keeney GL, Jakub JW, Degnim AC, Boughey JC. Cost-effectiveness analysis of routine frozen section analysis of breast margins compared with reoperation for positive margins. Ann Surg Oncol. 2011;18:3204–9.

37. Kobbermann A, etal. Impact of routine cavity shave margins on breast cancer re-excision rates. Ann Surg Oncol. 2011;18:1349–55.

38. Chagpar AB, etal. A randomized, controlled trial of cavity shave margins in breast cancer. N Engl J Med. 2015;373:503–10.

39. Jones V, et al. Excising additional margins at initial breast-conserving surgery (BCS) reduces the need for re-excision in a predominantly African American population: a report of a randomized prospective study in a public hospital. Ann Surg Oncol. 2016;23:456–64.

40. Schwarz J, Schmidt H.Technology for Intraoperative Margin Assessment in breast cancer. Ann Surg Oncol. 2020;27:2278–87. https://doi.org/10.1245/

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