Margin Matters: Advances in Intraoperative Margin Assessment for Breast-Conserving Surgery

Area of Science:

• Surgical Oncology
• Medical Imaging
• Biotechnology

Background:

• Breast cancer is the most common female neoplasm, with breast-conserving surgery increasingly preferred over mastectomy.
• Achieving negative margins while preserving glandular tissue in breast-conserving surgery remains a significant challenge.
• Traditional intraoperative margin assessment methods have limitations including time, interpretation, and operator dependency.

Purpose of the Study:

• To critically evaluate conventional and emerging intraoperative margin assessment techniques in breast-conserving surgery.
• To highlight the clinical utility, limitations, and potential of these techniques in reducing re-excision rates.
• To assess the impact on patient outcomes and cosmetic results.

Main Methods:

• Systematic literature review of PubMed and Google Scholar databases.
• Search terms included specimen radiography, intraoperative ultrasonography, mass spectrometry, optical coherence tomography, and artificial intelligence.
• Study selection based on relevance, language, completeness, and author consensus.

Main Results:

• Conventional techniques are valuable for reducing re-excisions and maintaining cosmetic outcomes.
• Emerging technologies like MarginProbe, fluorescence imaging, mass spectrometry, OCT, and AI-enhanced imaging offer real-time feedback and improved accuracy.
• Widespread adoption of emerging tools is hindered by cost, training requirements, and data variability.

Conclusions:

• Further investment in standardized protocols and multicenter trials is crucial for emerging technologies.
• Integrating imaging, spectroscopy, and AI presents a promising framework for enhancing surgical outcomes.
• Improved intraoperative margin assessment can lead to better quality of life for breast cancer patients.