Breast-Conserving Surgery: Challenges and Solutions for Positive Margins

In 2015, around 300,000 new cases of invasive and noninvasive breast cancer were diagnosed in women in the United States. Out of these cases, 60 to 75% of patients opted for breast-conserving surgery (BCS) as their initial treatment. The main objective of BCS is to remove the tumor along with a margin of healthy tissue, ensuring that no cancer cells are left at the cutting edge. Having negative margins, where no tumor is found at the edge of the surgical specimen through histologic analysis, is the current standard as it reduces the risk of local recurrence. However, patients with cancer cells at the cut margin, known as positive margins, often require a second surgery to obtain clear margins. These additional surgeries increase healthcare costs, pose risks of complications, burden patients physically and emotionally, and can potentially delay further necessary treatment.

Various techniques have been used to minimize the occurrence of positive margins and avoid re-excision surgeries, but they have been found to be ineffective, difficult for surgeons to master, or time-consuming for large specimens. Consequently, despite the use of preoperative and intraoperative methods, a significant percentage of patients undergoing BCS still require second surgeries due to positive surgical margins.