Surgical Margins in Breast Conservation

Copyright © 2013 Sheldon Marc Feldman. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Signi�cant progress has been made in the diagnosis and treatment of breast cancer during the past 30 years. e increased availability of screening mammography has resulted in a higher percentage of woman being diagnosed with early stage disease allowing the option of breast conservation therapy to be more widely available. Long-term follow-up studies clearly demonstrate equivalent survival with breast conservation surgery (lumpectomy) and radiotherapy versus total mastectomy [1, 2, 3]. e importance of obtaining clear lumpectomy surgical margins has been well established in minimizing the risk of local recurrence [4]. Unfortunately there is a lack of uniform guidelines in terms of what constitutes an adequately clear lumpectomy margin. Substantial debate about bigger margins being better continues [5]. is has led to wide variations in lumpectomy margin reexcision rates from 15 to 47% [6]. ese additional surgical procedures cause signi�cant patient distress, utilize health care resources, and can adversely affect cosmesis. From the patient perspective, they may wonder why we did not get it right the �rst time. ey want their cancer gone while maintaining a normal appearance. is special issue highlights the areas of controversy and demonstrates current best practices and emerging novel approaches towards optimal breast conservation approach. e goal is to improve our ability to provide breast-conserving approaches for breast cancer while avoiding multiple surgical procedures, minimizing recurrence risk while obtaining excellent cosmesis. We have chosen 6 of 16 submissions to be published in this special issue. Each paper was evaluated by at least two expert reviewers and revised according to review comments. P. Ananthakrishnan et al. provide an excellent comprehensive review article on all aspects involved in optimizing breast conservation. ey include discussion of preoperative breast imaging, lesion localization, impact of tumor biology and systemic therapy, intraoperative lesion identi�cation and margin assessment techniques, the role of margin ablation and oncoplastic techniques. ey also discuss the promise of ductal anatomy mapping toward the goal of validating the " Sick lobe hypothesis " [7, 8] which may allow for more accurate identi�cation of breast tissue to be targeted for excision. R. Emmadi and E. L. Wiley provide an excellent review from the pathology perspective of the different approaches to margin assessment. ey explore …