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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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Pre- and intraopertive NIRF optical imaging in an animal model. NIRF optical imaging with a protease-activatable fluorescent probe before (b) and after (d) surgical excision of the primary breast tumor in a nude mouse model. After initial excision of the tumor, a small area of residual disease could be detected (d). Normal photographs were taken for comparison (a, c)
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Fig3: Pre- and intraopertive NIRF optical imaging in an animal model. NIRF optical imaging with a protease-activatable fluorescent probe before (b) and after (d) surgical excision of the primary breast tumor in a nude mouse model. After initial excision of the tumor, a small area of residual disease could be detected (d). Normal photographs were taken for comparison (a, c)

Mentions: An optical imaging technique commonly used is two-dimensional (2D) fluorescence reflectance imaging (FRI), also known as epi-illumination fluorescence imaging. FRI with a hand-held imaging device could complement BCT by visualizing tumor delineation, remnant disease, and pinpointing suspicious lymph nodes, thereby enabling the surgeon to detect (diagnostic) and excise (therapeutic) malignant tissue and possible residual disease at the same time (Figs. 1, 3).119,121,122,138Fig. 3


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)

Pre- and intraopertive NIRF optical imaging in an animal model. NIRF optical imaging with a protease-activatable fluorescent probe before (b) and after (d) surgical excision of the primary breast tumor in a nude mouse model. After initial excision of the tumor, a small area of residual disease could be detected (d). Normal photographs were taken for comparison (a, c)
© Copyright Policy
Related In: Results  -  Collection

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

Fig3: Pre- and intraopertive NIRF optical imaging in an animal model. NIRF optical imaging with a protease-activatable fluorescent probe before (b) and after (d) surgical excision of the primary breast tumor in a nude mouse model. After initial excision of the tumor, a small area of residual disease could be detected (d). Normal photographs were taken for comparison (a, c)
Mentions: An optical imaging technique commonly used is two-dimensional (2D) fluorescence reflectance imaging (FRI), also known as epi-illumination fluorescence imaging. FRI with a hand-held imaging device could complement BCT by visualizing tumor delineation, remnant disease, and pinpointing suspicious lymph nodes, thereby enabling the surgeon to detect (diagnostic) and excise (therapeutic) malignant tissue and possible residual disease at the same time (Figs. 1, 3).119,121,122,138Fig. 3

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