Breast cancer is increasingly diagnosed due to improved accessibility to screening programs and new systemic therapies, leading to more frequent early diagnoses and improved outcomes. Breast conserving surgery aims to remove the tumor and surrounding disease-free tissue with maximal preservation. Guidelines recommend negative margins for invasive breast cancer and at least 2 mm margins for ductal carcinoma in situ. Positive margins are associated with an increased risk of local recurrence, often requiring re-excision and impacting quality of life. The challenge is to achieve negative margins while preserving healthy glandular tissue for aesthetic outcomes. The gold standard for margin evaluation has been intra-operative histological frozen section evaluation, but it has drawbacks such as false positives and increased operative times.
The cavity shave margins technique requires minimal removal of the breast lesion and ensures all margins are fully cleared of any remaining breast tissue. Literature suggests that cavity shave margins may lower the occurrence of positive margins and the need for additional surgeries while maintaining oncological safety and aesthetic outcomes. However, the method for assessing resection margins during breast conserving surgery can differ based on tumor and surgeon-specific factors.
Ultimately, the goal of breast cancer surgery is to remove all margins cancerous cells from the breast. If any cancer cells are left behind, it increases the risk of recurrence and can lead to further complications and the need for additional treatment.
Cavity Shave Margins
Cavity shaving (CS) is a surgical method utilized for treating breast cancer (BC). Its purpose is to decrease margin positivity during histologic evaluation, lowering the necessity for further breast conserving surgery (BCS).
What are Margins in Breast Cancer?
After the surgical removal of breast cancer (in a surgical biopsy, lumpectomy or mastectomy), the area surrounding the tumor, known as a margin, is taken out as well. This margin indicates whether the entire tumor was removed or not.
Breast cancer margins indicate the amount of normal tissue surrounding the tumor removed during breast cancer surgery. Typically measured in millimeters (mm), margins range from 0 mm (no margin) to several centimeters. They assist doctors in evaluating whether all cancerous cells have been effectively removed or if there are remaining cancer cells that could lead to a recurrence.
During breast cancer surgery, the surgeon meticulously removes affected tissue from the breast and sends it to a pathologist for examination. The pathologist then analyzes the tissue under a microscope to identify any cancer cells at the outer edge of the removed tissue.
Classifications for Breast Cancer Margins
A pathologist studies the tissue removed during surgery under a microscope in order to determine whether the margins contain cancer cells and identify the type of margin cells. There are three main classifications for breast cancer margins: clear, positive, and close.
What are Clear Margins in breast cancer?
Negative margins (also called clean, not involved, or clear margins) don’t have cancer cells at the outer edges. (The edges of the tissue removed from the breast only consist of normal tissue.) This is considered the best outcome, as individuals with clear margins have a reduced risk of cancer recurrence and may only require radiation therapy to finish their treatment.
Positive Margins
If cancer cells are detected at the edges of the removed tissue, it is considered a positive margin, indicating that the removal may not have been completely successful, raising the risk of cancer recurrence.
When positive margins are present, the surgeon may need to perform another procedure to remove additional tissue to ensure that all cancer cells are removed.
If positive margins are found after breast conserving surgery, you may choose to have more tissue removed or consider a mastectomy.
Close Margins
A small amount of space between the outer edge of the removed tissue and the cancer cells characterizes close margins. In the breast, there may still be some cancer cells present, which increases the risk for recurrence compared to those with clear margins. Your doctor might suggest additional treatment to eliminate or destroy any remaining cancer cells.
Does clear margins mean the end of cancer?
It’s important to keep in mind that even if your margins are clear, it’s not a definite assurance that you are cancer-free. There’s still a chance of undetected cancer cells being present in other areas of the breast or the body. It’s crucial to stay consistent with your regular screenings and follow-up appointments to watch out for any potential signs of cancer recurrence.
A randomized controlled trial of cavity shave margins in breast cancer
A standard operation for breast cancer involves removing part of the breast, known as a partial mastectomy. However, sometimes the edges of the tissue removed, known as the margins, still contain cancer cells. In a randomized controlled trial of cavity shave margins in breast cancer study, researchers compared two groups of patients undergoing partial mastectomy to see if removing additional tissue around the cavity left by the surgery, a procedure called cavity shave margins, reduced the rates of positive margins and the need for further surgery to remove remaining cancer cells.
In the study, 235 patients with stage 0 to III breast cancer were randomly assigned to have cavity shave margins resected (shave group) or not resected (no-shave group) at the time of their partial mastectomy. The primary outcome was the rate of positive margins, with secondary outcomes including cosmesis (the final appearance of the breast) and the amount of tissue removed.
The results showed that patients in the cavity shave margins group had a significantly lower rate of positive margins compared to those in the no-shave group. Additionally, patients in the shave group were less likely to need a second surgery to clear the margins. There was no significant difference in complications between the two groups.
In conclusion, cavity shaving margins during partial mastectomy reduced the rates of positive margins and reexcision among patients with breast cancer.
What are the equipment that help to detect positive margins?
Detecting positive margins, particularly in the context of breast cancer surgery, involves various equipment and technologies to ensure comprehensive and accurate assessment. Here are some key tools and equipment used in this process:
Cancer Diagnostic Probe (CDP)
Breast-Conserving Surgery (BCS) aims to remove cancerous tumors with enough margin to prevent the need for further surgery. However, if cancerous cells remain at the edges of the removed tissue, there is a higher risk of cancer recurrence. To address this, the Cancer Diagnostic Probe (CDP) is used to check the margins of the surgical cavity immediately after tumor removal. The CDP is designed to detect high-risk pre-cancer/cancer cells in cavity side margins and cancerous cells in the lymph nodes of breast cancer surgery patients in real-time, alongside frozen-section and permanent pathologies. This real-time detection can help ensure there are no remaining cancerous in Breast Cavity Margins cells, potentially reducing the need for additional surgeries and minimizing emotional and physical strain on patients.
Gamma Probe
The high incidence of breast cancer in women leads to numerous annual breast surgery procedures to remove malignant tumors. Detecting and removing cancerous lymph nodes (sentinel nodes) is crucial to preventing the spread of cancer in the patient. Several methods of varying accuracy are currently available for detecting sentinel nodes, with the Gamma Probe being widely used by surgeons due to its ease of use and ability to detect and localize sentinel lymph nodes in breast cancer and certain male cancers. The all-in-one version of the gamma Probe Manufacturers is a fully mobile system designed as a precise instrument that operates without cumbersome cables. This version combines the console and probe with a display, eliminating the need for a separate console. It supports Bluetooth connection, allowing users to use its main display or connect it to a mobile device for multiple displays. Its ultra-lightweight and compact dimensions make it easy to transport from one operating room to another. The Gamma Probe is a compact and highly sensitive device designed for detecting and precisely locating sentinel nodes with accuracy. Gamma Probe Manufacturers have designed it to be portable and provide high sensitivity for the accurate detection of sentinel nodes.
Impedimetric Tumor Detection System
Breast Imaging Reporting and Data System (BIRADS) categorizes breast abnormalities on a scale from BIRADS-1 to BIRADS-5 based on their likelihood of being cancerous. Follow-up examinations are required every 3 to 6 months for BIRADS-3 abnormalities, while BIRADS-4a and higher necessitate a biopsy. However, the limitations of sonography in detecting these abnormalities often result in delays in patient treatment and necessary biopsies.
To address these challenges, the Impedimetric Tumor Detection System (ITDS) has been developed. This innovative technology features a specially designed probe that is inserted into the patient’s body under ultrasound guidance and removed within seconds, with test results promptly displayed. ITDS is particularly advantageous for young patients with dense breast tissue, especially those with BIRADS-3 masses that are challenging to evaluate with mammography. Furthermore, patients with BIRADS-3 masses and a family history of breast cancer can benefit from this system. The device also plays a critical role in distinguishing simple fibroadenomas from complex fibroadenomas and phyllodes tumors.
Hospitech Cancer Care Innovations for Breast Cancer
Hospitech Cancer Care Innovations Company is leading the way in revolutionizing breast cancer diagnosis with its innovative range of devices such as the Cancer Diagnostic Probe (CDP), Impedimetric Tumor Detection System (ITDS) & Gamma Probe.
These state-of-the-art technologies are designed to enhance cancer detection and treatment effectiveness. Supported by research, articles, and patents, these tools provide precise results for early diagnosis and improved patient outcomes. The company takes pride in its dedicated team and unwavering commitment to making a significant impact in the healthcare industry’s battle against cancer.
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