1
|
Bouzaiene H, Triki A, Ghalleb M, Chemlali M, Benzarti Z, Ben Hassouna J, Gammoudi A, Rahal K. Is the systematic circumferential tumor cavity shaving a representative sample for the remaining mammary gland? About 75 cases. Breast 2017. [PMID: 28644994 DOI: 10.1016/j.breast.2017.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION The conservative surgery is more and more indicated for breast cancer. However, we still fear local recurrence which is mostly due to residual tumors?. Several techniques have been used to minimize theses residual tumors; one of them is the systematic circumferential tumor cavity shaving (SCTCS). METHODS We sampled 75 female patients who had conservative surgery with positive shaved margins in the anatomopathology examination and to whom a complementary treatment with mastectomy have been decided. RESULTS The median age was 48 years old. The median tumor size was 23 mm. In the histological examination of the tumors, 93% were invasive ductal carcinoma associated in 50% of the cases to the presence of ductal carcinoma in situ (DCIS) where all the lumpectomies had clear margin. For the SCTCS, 62,2% were DCIS and in 17,6% of the cases were invasive ductal carcinoma. A complementary treatment with mastectomy was indicated to all the patients. A residual tumor was detected in the remaining mammary gland in 47,7% of the cases out of which 50% were DCIS. Local recurrence happened in three patients (4,6%) after a median of follow up of 36 months. The overall survival and the disease free survival at five years were respectively 83,6% and 75,5%. CONCLUSION Standardized lumpectomy cavity shaving provides a backup to lumpectomy margins in conservative breast surgery but it can also be used as a sample for the remaining breast, helping to detect the residual tumor, and decreasing the rates of local recurrence after BCT.
Collapse
Affiliation(s)
- H Bouzaiene
- Surgical Oncology Department, Institute Salah Azeiz of Oncology, Tunis, Tunisia
| | - A Triki
- Surgical Oncology Department, Institute Salah Azeiz of Oncology, Tunis, Tunisia
| | - M Ghalleb
- Surgical Oncology Department, Institute Salah Azeiz of Oncology, Tunis, Tunisia.
| | - M Chemlali
- Surgical Oncology Department, Institute Salah Azeiz of Oncology, Tunis, Tunisia
| | - Z Benzarti
- Surgical Oncology Department, Institute Salah Azeiz of Oncology, Tunis, Tunisia
| | - J Ben Hassouna
- Surgical Oncology Department, Institute Salah Azeiz of Oncology, Tunis, Tunisia
| | - A Gammoudi
- Anatomopathology Department, Institute Salah Azeiz of Oncology, Tunis, Tunisia
| | - K Rahal
- Surgical Oncology Department, Institute Salah Azeiz of Oncology, Tunis, Tunisia
| |
Collapse
|
2
|
Systematic cavity shaving: modifications of breast cancer management and long-term local recurrence, a multicentre study. Eur J Surg Oncol 2013; 39:899-905. [PMID: 23773800 DOI: 10.1016/j.ejso.2013.05.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/27/2013] [Accepted: 05/08/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The status of the surgical margins of lumpectomy is one of the most important determinants of local recurrence in breast cancer. Systematically practicing cavity margin resection is debated but may avoid surgical re-excision and allow the diagnosis of multifocality. METHODS This multicentric retrospective study included 294 patients who underwent conservative management of breast cancer with 2-4 systematic cavity shavings. Clinico-biological characteristics of the patients were collected in order to establish whether surgical management was modified by systematic cavity shaving. Local recurrence rate with a long-term follow up of minimum 4 years was evaluated. RESULTS Cavity shaving avoided the need for re-excision in 25% of cases and helped in the diagnosis of multifocality in 8% of cases. Resection volume was not associated with usefulness of the cavity shaving. No predictive factor of positive cavity shaving was found. The rate of local recurrence was 3.7% and appeared in a median time of 3 years and 8 month. Only one quarter of the patients with local recurrence had initially positive lumpectomy margins but negative cavity shaving. DISCUSSION Systematic cavity shaving can change surgical management of conservative treatment. No specific target population for useful cavity shaving was found, such that we recommend utilising it systematically.
Collapse
|
3
|
Feron JG, Nguyen A, Bézu C, Antoine M, Darai E, Coutant C, Rouzier R, Uzan S. Interest in cavity shaving in breast conservative treatment does not depend on lumpectomy technique. Breast 2011; 20:358-64. [DOI: 10.1016/j.breast.2011.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 06/17/2010] [Accepted: 01/19/2011] [Indexed: 11/15/2022] Open
|
4
|
CHIE EK, KIM K, HAN W, NOH DY, OH DY, IM SA, KIM TY, BANG YJ, HA SW. Results of breast-conserving therapy for multifocal or multicentric breast cancers. Asia Pac J Clin Oncol 2009. [DOI: 10.1111/j.1743-7563.2009.01224.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
5
|
Hewes JC, Imkampe A, Haji A, Bates T. Importance of routine cavity sampling in breast conservation surgery. Br J Surg 2008; 96:47-53. [DOI: 10.1002/bjs.6435] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Background
The role of cavity biopsy (CB) at the time of wide local excision (WLE) for primary breast cancer has not been evaluated fully. This study compared four groups of patients to determine the significance of margins and CB histology on tumour characteristics and outcome.
Methods
This was a retrospective study of patients undergoing WLE and CB in one institution over 21 years. Demographic data, tumour characteristics and survival information were obtained. Four subgroups of patients were compared according to their margin and cavity status (positive or negative).
Results
A total of 957 patients had WLE. The median 10-year survival was 85·6 per cent and breast cancer-specific survival was 92·4 per cent. Tumour size, grade, node and oestrogen receptor status were independent predictors of survival. There was poor concordance between positivity of resection margins and CB (32·0 per cent); a negative margin carried a 10·8 per cent risk of demonstrable residual disease. A positive CB, but not a positive margin, was associated with reduced overall survival and breast cancer-specific survival.
Conclusion
Cavity status was more significant with regard to survival than margin status. CB is important in identifying residual and multifocal disease, as margin and cavity positivity are often not concordant.
Collapse
Affiliation(s)
- J C Hewes
- The Breast Unit, William Harvey Hospital, Kennington Road, Willesborough, Kent TN24 0LZ, UK
| | - A Imkampe
- The Breast Unit, William Harvey Hospital, Kennington Road, Willesborough, Kent TN24 0LZ, UK
| | - A Haji
- The Breast Unit, William Harvey Hospital, Kennington Road, Willesborough, Kent TN24 0LZ, UK
| | - T Bates
- The Breast Unit, William Harvey Hospital, Kennington Road, Willesborough, Kent TN24 0LZ, UK
| |
Collapse
|
6
|
Vallejo da Silva A, Destro C, Torres W. Oncoplastic surgery of the breast: Rationale and experience of 30 cases. Breast 2007; 16:411-9. [PMID: 17374485 DOI: 10.1016/j.breast.2007.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 01/31/2007] [Indexed: 10/23/2022] Open
Abstract
A definition of oncoplastic surgery of the breast is presented, and its objectives and advantages over the usual conservative procedures are discussed. The oncological safety of these procedures are demonstrated, especially in surgery of larger tumors. Technical possibilities are discussed and a classification of the procedures presented. Data from 30 cases operated in our institution are depicted. The need for better training of the breast surgeon is discussed and the advantages of the same surgeon to perform the whole procedure presented.
Collapse
Affiliation(s)
- André Vallejo da Silva
- Breast Service, Antônio Pedro Universitary Hospital, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil.
| | | | | |
Collapse
|
7
|
Klimberg VS, Kepple J, Shafirstein G, Adkins L, Henry-Tillman R, Youssef E, Brito J, Talley L, Korourian S. eRFA: Excision Followed by RFA—a New Technique to Improve Local Control in Breast Cancer. Ann Surg Oncol 2006; 13:1422-33. [PMID: 17009144 DOI: 10.1245/s10434-006-9151-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2006] [Revised: 07/30/2006] [Accepted: 07/31/2006] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Excision followed by RFA (eRFA) may allow improved cosmesis while ensuring negative margins in patients with breast cancer. This technique utilizes heat to create an additional tumor-free zone around the lumpectomy cavity. We hypothesized that eRFA will decrease the need for re-excision of inadequate margins. METHODS Between July 2002 and January 2005, we conducted a multiphase trial of RFA of prophylactic mastectomy specimens and of women desiring lumpectomy. In both models, a lumpectomy was performed, the RFA probe was deployed 1 cm circumferentially into the walls of the lumpectomy cavity and maintained at 100 degrees C for 15 min. Whole mount slides were used to measure the zone of ablation for ex vivo specimens. Hematoxylin and eosin staining of in vivo lumpectomy margins < 3 mm was considered inadequate. RESULTS Nineteen prophylactic mastectomy ablations revealed a consistent perimeter of ablation. Forty-one patients (mean age 63 +/- 14 years) had an average tumor size of 1.6 +/- 1.5 cm underwent in vivo eRFA, and 25% had inadequate margins: one focally positive, one < 2 mm, eight < 1 mm and one grossly positive. Only the grossly positive margin was re-excised. Overall complication rate of in vivo ablations was 7.5%. Twenty-four of 41 patients did not have post-eRFA XRT. No in-site local recurrences have occurred during a median follow-up of 24 months (12-45 months). Two patients have occurred elsewhere. CONCLUSIONS The ex vivo ablation model reliably created a 5-10 mm perimeter of ablation. In vivo, this zone reduced the need for re-excision for inadequate margins by 91% (10/11). Short-term follow-up suggests that eRFA could reduce re-excision surgery and local recurrence.
Collapse
Affiliation(s)
- V Suzanne Klimberg
- Department of Surgery, Division of Breast Surgical Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
|
9
|
Vicini FA, Goldstein NS, Pass H, Kestin LL. Use of pathologic factors to assist in establishing adequacy of excision before radiotherapy in patients treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 2004; 60:86-94. [PMID: 15337543 DOI: 10.1016/j.ijrobp.2004.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2003] [Revised: 01/28/2004] [Accepted: 02/03/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND We reviewed our experience in patients with early-stage breast carcinoma treated with breast-conserving therapy (BCT) to identify pathologic factors useful in defining the adequacy of excision before radiotherapy (RT). METHODS AND MATERIALS All slides from 607 consecutively treated cases of Stage I-II breast carcinoma were reviewed by one pathologist. Numerous pathologic factors were evaluated for their association with ipsilateral breast failure (IBF). Margin distance was classified as negative, near (<0.50 low-power field), or positive. The amount of carcinoma near the final margin was measured as the width of invasive carcinoma and number of ducts with carcinoma in situ near the margin and divided into three groups: near-least, near-intermediate, and near-greatest amount. The median follow-up was 8.5 years. RESULTS Patients with negative, near-least, near-intermediate, and near-greatest amount of carcinoma near the margin, and positive final margins had a 12-year IBF rate of 9%, 6%, 18%, 24%, and 30%, respectively. On multivariate analysis, only the amount of carcinoma near the margin was independently associated with IBF (p <0.001). To help explain these observations, 441 initial and reexcision specimens were examined. The amount of carcinoma near the initial margin and the invasive carcinoma/specimen maximal dimension ratio were significantly associated with greater amounts of residual carcinoma in adjacent breast parenchyma. CONCLUSION The amount of carcinoma near the margin, in addition to margin status, appears to be directly related to an increased risk of IBF in patients treated with BCT. Pathologic factors that incorporate the amount of excised breast parenchyma and amount of carcinoma near the margin may be useful to clinicians in deciding whether a patient has undergone adequate excision for BCT.
Collapse
MESH Headings
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Guidelines as Topic
- Humans
- Neoplasm, Residual
- Retrospective Studies
Collapse
Affiliation(s)
- Frank A Vicini
- Department of Radiation Oncology, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI 48073, USA.
| | | | | | | |
Collapse
|
10
|
Abstract
Identification of early-stage breast cancers has increased over the past 2 decades primarily because of mammographic screening. The general guidelines to management of breast cancer may not apply to the smallest of these tumors, as their metastatic potential may be smaller than larger tumors. Tumors < 5 mm (T1a) carry an excellent prognosis, despite a variety of treatment approaches. However, some patients' cancer returns. There appear to be some histologic features that can predict a higher risk of axillary metastases, and therefore, a higher risk of distant metastases. Controversy exists over the extent of treatment, as to whether less than conventional treatment, such as mastectomy, axillary evaluation, and breast-conserving surgery and radiation, can be done. T1a lesions associated with extensive ductal carcinoma in situ and T1a lesions in young patients should be treated with caution if less than conventional breast treatment is to be considered. In older patients with good histologic features, axillary assessment may not be necessary. Very wide excision alone may be appropriate for some patients, but partial breast irradiation is under study and may provide a reasonable compromise. Systemic therapy for node-negative patients is not recommended. Recurrences within the breast occur later in early-stage breast cancers than with extensive-stage breast cancers, requiring annual imaging and evaluation for many years.
Collapse
Affiliation(s)
- Krystyna D Kiel
- Department of Radiation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
| |
Collapse
|
11
|
Gennaro M, Ferraris C, Guida V, Tomasic G, Carcangiu ML, Greco M. Conservative surgery in breast cancer. Significance of resection margins. Breast 2004; 10:432-7. [PMID: 14965620 DOI: 10.1054/brst.2001.0297] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2000] [Revised: 01/17/2001] [Accepted: 01/23/2001] [Indexed: 11/18/2022] Open
Abstract
We approached the issue of surgical margins in the conservative treatment of breast cancer by examining the literature germane to four precise questions: At what distance from the macroscopic margin of the tumour should the resection margin be? To what extent do histologically clear resection margins indicate complete local control of the disease? To what extent do histologically involved margins indicate persistence of disease? and Does the local recurrence rate correlate with the status of the resection margin? We propose categorizing margin involvement into five groups (absent, focal, minimal, moderate and extensive involvement) according to strict histological criteria, and assigning increasingly aggressive subsequent treatments according to the extent of any margin involvement.
Collapse
Affiliation(s)
- M Gennaro
- Breast Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
| | | | | | | | | | | |
Collapse
|
12
|
|
13
|
Abstract
As little time ago as 1991 the NIH Consensus conference could not agree on the need for negative margins. Today, negative margin status has become a prerequisite for BCT recognizing that positive margins impact negatively on local recurrence rates. The science of margin evaluation is fast becoming recognized to play a key role in providing patients with the opportunity for breast conservation therapy as well as the best possible cosmetic result. Preoperative factors that predict a greater likelihood of failure to obtain margins such as larger tumor size and positive lymph nodes are fixed and can only be dealt with by taking larger biopsies. RODEO-MRI can preoperatively predict probability of success or failure and can actual better define tumor dimensions and extent and help plan excisions. Use of intraoperative US may be a future tool used to facilitate the excision of non-palpable and possibly palpable tumors. Intraoperative pathological assessment should not be performed by frozen section but consideration given to cytological assessment so as to allow feedback to the surgeon intraoperatively as to which margin needs more attention. Finally, using all the above methods of obtaining negative margins, the surgeon may have the ability to impact the outcome of breast cancer surgery and recurrence.
Collapse
Affiliation(s)
- V S Klimberg
- Department of Surgery, University of Arkansas for Medical Sciences, Arkansas Cancer Research Center, John L. McClellan Veterans' Administration Hospital, Little Rock 72205, USA
| | | | | |
Collapse
|
14
|
Rapid Intraoperative Scrape Cytology Assessment of Surgical Margins in Breast Conservation Surgery. Breast Cancer 1998; 5:165-169. [PMID: 11091642 DOI: 10.1007/bf02966689] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Rapid intraoperative scrape cytologic examination for diagnosing surgical margin involvement of specimens obtained by breast conservation surgery was evaluated. Four surgical margins(nipple side, two lateral sides and distal side)of the removed breast tissue were cytologically examined and histologically compared following segmentectomy in 50 breast cancer patients(200 margins). Intraductal carcinoma had a tendency to spread most extensively to the nipple, compared with other margins. The margin positive rate of tumors with ductal spread(DS)of over 20mm was significantly higher than in tumors with a DS under 20 mm(52.2% vs 7.4%)(P < 0.001). of 50 canditates 10 patients underwent total mastectomy due to positive margins on repeat cytologic examination after re-excision. Four of the 10 patients had an extensive intraductal component on microscopy. The sensitivity, specificity and accuracy of cytology were 96.4 %, 90.7% and 91.5%, respectively.Scrape cytology is useful to determine surgical margin involvement after segmentectomy for breast cancer, although overestimation of involvement will tend to result.
Collapse
|
15
|
Okano K, Fukutomi T, Tsuda H, Tanaka SA, Nanasawa T, Kanai Y. Local Recurrence after Conservative Surgery without Postoperative Radiation for Pure Tubular Carcinoma of the Breast:A Case Report with Reference to Multifocality of Tubular Carcinoma. Breast Cancer 1998; 5:201-204. [PMID: 11091649 DOI: 10.1007/bf02966696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 49-year-old premenopausal woman with stage I breast carcinoma underwent left quadrantectomy with axillary dissection in 1992. The tumor was 0.7x0.5 cm Histopathologically, this was a pure tubular carcinoma without lymph node metastasis or lymphatic or vascular invasion. Although the surgical margin was pathologically negative, atypical ductal hyperplasia was present close to the cut margin's edge. Neither adjuvant chemotherapy nor radiotherapy had been given after the operation. Approximately 5 years after the first surgery, she had a local recurrence in the vicinity of the operative wound. There was no clinical evidence of distant metastasis. A salvage mastectomy was performed. Histopathological examination revealed that the second tumor was an invasive ductal carcinoma, histological grade 2, with extensive intraductal component. It was difficult to determine whether this was a true in-breast recurrence or a second primary cancer. Overexpression of p53 and c-erbB-2 was observed in the second tumor. Estrogen receptor and progesterone receptor were both negative. No postoperative chemotherapy was given. Multifocality and atypical ductal hyperplasia were observed in 7(87.5%)and 6(75%) of 8 patients, respectively, with tubular carcinoma between 1991and 1997 at the National Cancer Center Hospital. Coexisting disease associated with tubular carcinoma suggests that radiotherapy may be an important component of breast conservation treatment to prevent local recurrence in this type of tumor.
Collapse
Affiliation(s)
- K Okano
- Department of Surgical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104, Japan
| | | | | | | | | | | |
Collapse
|
16
|
Abstract
Breast MRI is becoming an important tool for the improved management of breast cancer. The technical attributes of high contrast, high-resolution breast MRI acquisitions are summarized. The fundamentals of image interpretation are outlined, including lesion enhancement, morphological features, and extent categories. The indications for breast MRI include compromised mammography, staging of disease within the breast and adjacent structures, difficult histology, and other special diagnostic situations. Patients with compromised mammography include previous surgery, radiographically dense breasts, and silicone augmentation. The improved determination of disease extent aids in the management of breast conservation treatment. Certain lesions, particularly lobular carcinoma and ductal carcinoma in situ, can be better managed with the information available with breast MRI. Other potential indications are also discussed, including patients presenting with positive axillary nodes and no known primary, women with a high risk of malignancy, and recently postoperative breasts with positive margins. The need for MRI stereotaxis is reviewed, with indications and potential solutions. The potential future roles for MRI-directed interstitial hyperthermia are outlined.
Collapse
Affiliation(s)
- S E Harms
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock 72205, USA
| |
Collapse
|
17
|
Abstract
Breast conserving therapy (BCT) was conducted in 22.1% of breast cancer patients in 1994 in Japan and is being performed with increasing frequency. According to the data already published, 10-27% of patients treated with BCT had a positive surgical margin. The recurrence rate in the breast is 1-2% annually, The 5-year overall survival in patients mostly consisting of stage I is 90% or higher at the present time. A case-control analysis of a multicenter study revealed that significant risk factors for breast recurrence were a positive surgical margin and absence of radiation therapy. Progress in basic research and diagnosis has also been instrumental in improving treatment results.
Collapse
|
18
|
Abstract
Breast cancer diagnosis and treatment are important health care issues in the Industrialized World. About 180,000 new breast cancers are discovered annually in the United States. Because this cancer often occurs in premenopausal women, breast cancer is a leading cause of potential life years lost. Breast magnetic resonance imaging (MRI) is capable of producing detailed information concerning the extent and character of breast lesions. The technique and alternatives for generating high-resolution breast MR images are reviewed. Characteristic features of a pulse sequence for breast imaging includes heavy T1 weighting and magnetization transfer weighting for more effective gadolinium contrast, fat suppression, and rapid acquisition time. MRI is best employed for breast cancer diagnosis as a supplement to conventional breast imaging. Diagnostic groups particularly well suited to breast MRI include women with radiographically dense breasts, silicone augmentation, and postoperative scar. The capacity of breast MRI to show disease extent is employed to plan and localize for breast-conservation therapy. Tumor size and multiple tumors can be characterized for more-effective surgical management. Ductal carcinoma in situ can be imaged and staged for tailored therapy. MRI-directed biopsy and localization can be used to optimize lumpectomy surgery and reduce the potential for histologically positive margins. MRI can define the effectiveness of radiation therapy and chemotherapy to provide improved information on nonsurgical treatment of breast cancer. The clinical implementation of breast MRI in the future depends on the careful coordination of quality MRI images and interpretations with skillful therapeutic management.
Collapse
Affiliation(s)
- S E Harms
- University of Arkansas for Medical Services, USA
| |
Collapse
|