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Obtaining adequate surgical margins in breast-conserving therapy for patients with early-stage breast cancer: current modalities and future directions.

Pleijhuis RG, Graafland M, de Vries J, Bart J, de Jong JS, van Dam GM - Ann. Surg. Oncol. (2009)

Bottom Line: This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse affects on cosmesis, psychological distress, and health costs.In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher a priori risk for re-excision.Furthermore, innovative intraoperative approaches, such as positron emission tomography, radioguided occult lesion localization, and near-infrared fluorescence optical imaging, are addressed, which have to prove their potential value in improving surgical outcome and reducing the need for re-excision in BCT.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.

ABSTRACT
Inadequate surgical margins represent a high risk for adverse clinical outcome in breast-conserving therapy (BCT) for early-stage breast cancer. The majority of studies report positive resection margins in 20% to 40% of the patients who underwent BCT. This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse affects on cosmesis, psychological distress, and health costs. In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher a priori risk for re-excision. However, most risk factors are related to tumor biology and patient characteristics, which cannot be modified as such. Therefore, efforts to reduce the number of positive margins should focus on optimizing the surgical procedure itself, because the surgeon lacks real-time intraoperative information on the presence of positive resection margins during breast-conserving surgery. This review presents the status of pre- and intraoperative modalities currently used in BCT. Furthermore, innovative intraoperative approaches, such as positron emission tomography, radioguided occult lesion localization, and near-infrared fluorescence optical imaging, are addressed, which have to prove their potential value in improving surgical outcome and reducing the need for re-excision in BCT.

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Related in: MedlinePlus

New evolving imaging modalities for intraoperative margin assessment in breast-conserving therapy: (a) radioguided occult lesions localization (ROLL); (b) positron emission tomography (PET); and (c) near-infrared fluorescence (NIRF) optical imaging
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Fig1: New evolving imaging modalities for intraoperative margin assessment in breast-conserving therapy: (a) radioguided occult lesions localization (ROLL); (b) positron emission tomography (PET); and (c) near-infrared fluorescence (NIRF) optical imaging

Mentions: The oncologic applications of PET are still expanding with the development of new positron-emitting radiopharmaceuticals and imaging techniques.92 Recently, the suitability of 18F-FDG as a tracer for tumors has led to an interest in its use in PET–probe-guided BCT (Fig. 1). The radiopharmaceutical 18F-FDG demarcates sites of high glucose metabolic activity, such as tumors, inflammation, and infection.93 Because breast tumors frequently overexpress the facilitative glucose transporter GLUT1, uptake of the glucose analogue 18F-FDG may be increased in breast cancer cells.94,95Fig. 1


Obtaining adequate surgical margins in breast-conserving therapy for patients with early-stage breast cancer: current modalities and future directions.

Pleijhuis RG, Graafland M, de Vries J, Bart J, de Jong JS, van Dam GM - Ann. Surg. Oncol. (2009)

New evolving imaging modalities for intraoperative margin assessment in breast-conserving therapy: (a) radioguided occult lesions localization (ROLL); (b) positron emission tomography (PET); and (c) near-infrared fluorescence (NIRF) optical imaging
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2749177&req=5

Fig1: New evolving imaging modalities for intraoperative margin assessment in breast-conserving therapy: (a) radioguided occult lesions localization (ROLL); (b) positron emission tomography (PET); and (c) near-infrared fluorescence (NIRF) optical imaging
Mentions: The oncologic applications of PET are still expanding with the development of new positron-emitting radiopharmaceuticals and imaging techniques.92 Recently, the suitability of 18F-FDG as a tracer for tumors has led to an interest in its use in PET–probe-guided BCT (Fig. 1). The radiopharmaceutical 18F-FDG demarcates sites of high glucose metabolic activity, such as tumors, inflammation, and infection.93 Because breast tumors frequently overexpress the facilitative glucose transporter GLUT1, uptake of the glucose analogue 18F-FDG may be increased in breast cancer cells.94,95Fig. 1

Bottom Line: This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse affects on cosmesis, psychological distress, and health costs.In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher a priori risk for re-excision.Furthermore, innovative intraoperative approaches, such as positron emission tomography, radioguided occult lesion localization, and near-infrared fluorescence optical imaging, are addressed, which have to prove their potential value in improving surgical outcome and reducing the need for re-excision in BCT.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.

ABSTRACT
Inadequate surgical margins represent a high risk for adverse clinical outcome in breast-conserving therapy (BCT) for early-stage breast cancer. The majority of studies report positive resection margins in 20% to 40% of the patients who underwent BCT. This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse affects on cosmesis, psychological distress, and health costs. In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher a priori risk for re-excision. However, most risk factors are related to tumor biology and patient characteristics, which cannot be modified as such. Therefore, efforts to reduce the number of positive margins should focus on optimizing the surgical procedure itself, because the surgeon lacks real-time intraoperative information on the presence of positive resection margins during breast-conserving surgery. This review presents the status of pre- and intraoperative modalities currently used in BCT. Furthermore, innovative intraoperative approaches, such as positron emission tomography, radioguided occult lesion localization, and near-infrared fluorescence optical imaging, are addressed, which have to prove their potential value in improving surgical outcome and reducing the need for re-excision in BCT.

Show MeSH
Related in: MedlinePlus