Guidance in breast-conserving surgery: tumour localisation versus identification

Martha S Kedrzycki, Daniel S Elson and Daniel R Leff
Guidance in breast-conserving surgery: tumour localisation versus identification

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In breast-conserving surgery (BCS), the tumour is removed with the goal of preserving as much healthy breast tissue as possible. Breast conservation comes with a risk of positive resection margins, an independent predictor of ipsilateral tumour recurrence, necessitating reoperation1. Contemporary data from the UK Get it Right First Time1 suggest high average reoperation rates of around 19 %. Current tumour localization techniques can only guide surgeons to the tumour epicentre, but fail to provide identification of the boundary between tumour and normal tissue. Imaging techniques, such as intraoperative ultrasonography (IOUS), intraoperative MRI (iMRI) or fluorescence-guided surgery (FGS), enable visualization of the tumour in its entirety and may provide improved operative precision2–5.


In April 2022, a literature review was performed exploring localization and identification modalities in BCS. The PubMed electronic database was searched for the highest-quality evidence available for each modality.


Combining these novel margin assessment methods with FGS, which, unlike other identification modalities, is instantaneous and not dependent on patient position or operator skill level, would very likely enable a satisfactory rim of healthy tissue to be obtained. Not only will surgeons have real-time guidance on a macroscopic scale using FGS, but they will be able to further verify the resection at a microscopic level using these novel margin techniques.


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