Surgery for early and minimally invasive breast cancer

Limiting morbidity without sacrificing outcome remains paramount for patients with minimally invasive breast cancer, particularly regarding diagnosis, local disease control, limiting axillary dissection, and identifying the optimal timing for surgery. Stereotactic biopsy is evolving as a viable alternative to surgical biopsy, but it awaits confirmation in a randomized prospective study before its adoption on a routine basis. Breast-conserving therapy continues to offer local control rates similar to mastectomy, except for lesions with positive-excision margins, an extensive intraductal component, and perhaps in young patients and those with either lobular carcinoma or multifocal disease. Factors that provide prognostic information currently obtained by axillary dissection have not been identified, and hence axillary dissection remains a mainstay of treatment. Sentinel node biopsy requires further refinements and confirmation before its universal acceptance. Premenopausal patients undergoing surgery during the follicular phase of the menstrual cycle appear to fare poorly, thereby requiring further investigation.