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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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Schematic example of the mechanism behind an activatable probe. The probe is dark in its native state, thereby keeping unwanted background signals to a minimum (a). After cleavage of the backbone carrier by a specific enzyme, the probe will fluoresce when excited with light of a defined wavelength (b)
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Fig2: Schematic example of the mechanism behind an activatable probe. The probe is dark in its native state, thereby keeping unwanted background signals to a minimum (a). After cleavage of the backbone carrier by a specific enzyme, the probe will fluoresce when excited with light of a defined wavelength (b)

Mentions: It must be emphasized that NIRF imaging on itself is not possible without the use of near-infrared (NIR) fluorescent molecular probes (fluorochromes), for which several groups can be distinguished. One group consists of “targeted fluorochromes,” which are specific for certain biomarkers involved in breast cancer, such as vascular endothelial growth factor (VEGF) receptor, epidermal growth factor (EGF) receptor, or the Her2/neu receptor.127–132 Another group is formed by the “activatable probes,” which show virtually no fluorescence activity in their native state, thereby minimizing background signals.119 However, after activation by a specific enzyme, the probe emits a bright fluorescence signal when appropriately excited (Fig. 2).119,121,133 A number of enzymes that play a role in carcinogenesis and tumor spreading can already be visualized with activatable probes, including proteases, such as cathepsin B, cathepsin D, and matrix metalloproteinase 2 (MMP2).121,133–137Fig. 2


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)

Schematic example of the mechanism behind an activatable probe. The probe is dark in its native state, thereby keeping unwanted background signals to a minimum (a). After cleavage of the backbone carrier by a specific enzyme, the probe will fluoresce when excited with light of a defined wavelength (b)
© Copyright Policy
Related In: Results  -  Collection

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

Fig2: Schematic example of the mechanism behind an activatable probe. The probe is dark in its native state, thereby keeping unwanted background signals to a minimum (a). After cleavage of the backbone carrier by a specific enzyme, the probe will fluoresce when excited with light of a defined wavelength (b)
Mentions: It must be emphasized that NIRF imaging on itself is not possible without the use of near-infrared (NIR) fluorescent molecular probes (fluorochromes), for which several groups can be distinguished. One group consists of “targeted fluorochromes,” which are specific for certain biomarkers involved in breast cancer, such as vascular endothelial growth factor (VEGF) receptor, epidermal growth factor (EGF) receptor, or the Her2/neu receptor.127–132 Another group is formed by the “activatable probes,” which show virtually no fluorescence activity in their native state, thereby minimizing background signals.119 However, after activation by a specific enzyme, the probe emits a bright fluorescence signal when appropriately excited (Fig. 2).119,121,133 A number of enzymes that play a role in carcinogenesis and tumor spreading can already be visualized with activatable probes, including proteases, such as cathepsin B, cathepsin D, and matrix metalloproteinase 2 (MMP2).121,133–137Fig. 2

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