Margin evaluation in Breast Conservation Treatment

Dr. C. Gopalakrishnan NairDepartment of endocrine Surgery

College of Medicine

AIMS

Kochi, Kerala

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Criteria for BCT• Capability to deliver breast irradiation

• Likelihood of achieving a cosmetically acceptable result

• Ability to obtain margin negative lumpectomy

Margin evaluation in BCT

• Margin is characterised as the closest microscopic distance between the inked lumpectomy tissue edge and any cancerous tissue

Margin evaluation in BCT

• Operative practice is to have a 1 cm clearance

• Specimen is well oriented

Margin evaluation in BCT• Gage and colleagues( JCRT)• Schnit et al 1mm clearance from

the inked margin

• Patterson et al 2mm clearance from the inked margin

• Obedian et al

Margin evaluation in BCT

• Negative margin

• Close margin

• Focally positive margin

• Positive margin

Margin evaluation in BCT

• Result of BCT stratified by extent of margin

Schnitt Obedian

Negative 0 % 2.2 %

Close 4 % 2.1 %

Focally positive 6 % 9.1 %

Positive 21 % 13.2 %

Margin evaluation in BCT

• JCRT experience

ILR Distant metastasis

Negative 7% 25%

Close

Focally positive 14% 28%

Positive 28% 35%

Margin evaluation in BCT

• New techniques to improve lumpectomy margin

1. MRI2.Intra-op ultrasound

Margin evaluation in BCT

• Intraoperative Margin analysis1. Frozen section2. Shave biopsy3.Imprint cytology

Margin evaluation in BCT

• Preoperative needle biopsy

• Better to avoid surgical biopsy

Margin evaluation in BCT

• Pathological margin status and adjuvant systemic therapy are the most important associated features with LR in BCT