Breast-Conserving Surgery: Reducing the Need for Re-excision

In 2015, approximately 300,000 new cases of both invasive and noninvasive breast cancer were diagnosed in women in the United States. Out of these cases, 60 to 75% of women 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 normal tissue surrounding it, ensuring that no cancer cells are left at the cut margin. This is crucial because negative margins significantly reduce the chances of local recurrence.

When cancer cells are found at the cut margin (positive margin), it is often necessary for patients to undergo a second surgical procedure to achieve clear margins. These re-excision surgeries not only increase healthcare costs but also pose risks of complications, physically and psychologically burden the patients, and potentially delay recommended adjuvant treatments.

Various techniques have been employed to reduce the rate of positive margins and avoid the need for re-excision. However, these approaches have shown limited effectiveness in reducing the reoperation rate. They may also be challenging for surgeons to master or time-consuming for larger specimens. Consequently, despite the use of preoperative and intraoperative methods, 20 to 60% of patients undergoing BCS still require second surgeries due to positive surgical margins.