Breast-conserving surgery (BCS): Excising malignancy with intent to obtain adequate margins, which, based on cancer location, may include pectoralis fascia or skin
Connotes removal of cancer with intention to cure
Term also applies to reexcision for clear margins
Breast-conserving therapy (BCT): BCS followed by radiation therapy (XRT)
Margins: Tissue surrounding cancer
Amount of benign tissue between edge of malignancy and edge of resection
Adequate margin for local control: No ink on tumor in invasive cancer; 2-mm margin for DCIS
Also used to connote additional tissue taken at lumpectomy edges, a.k.a. "cavity margins" if from all sides
Quadrantectomy (segmentectomy): Resection of triangular segment of breast (apex at nipple), including skin and pectoralis fascia
Based on segmental growth of cancer; used more often in European centers
Option for larger cancers with enough remaining breast; often requires oncoplastic closure for acceptable cosmetic result
Excisional biopsy: Removal of abnormality for diagnosis
Incisional biopsy: Removal of part of abnormality for diagnosis
Oncoplastic BCS
Cancer removed with wide margins to reduce positive margins and reexcision rates
Improves cosmetic outcomes, especially for larger tumors
Remaining breast tissue surgically reapproximated to achieve acceptable cosmetic result
Can result in breast asymmetry; may need reduction/lift of contralateral breast
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Expected Outcome
Things to Do
OUTCOMES
Complications
Selected References
Gray RJ et al: Intraoperative margin management in breast-conserving surgery: a systematic review of the literature. Ann Surg Oncol. 25(1):18-27, 2018
Arthur DW et al: NRG Oncology-Radiation Therapy Oncology Group Study 1014: 1-year toxicity report from a phase 2 study of repeat breast-preserving surgery and 3-dimensional conformal partial-breast reirradiation for in-breast recurrence. Int J Radiat Oncol Biol Phys. 98(5):1028-35, 2017
Correa C et al: Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract Radiat Oncol. 7(2):73-9, 2017
Jeffries DO et al: Localization for breast surgery: the next generation. Arch Pathol Lab Med. 141(10):1324-29, 2017
Mamounas EP et al: 21-gene recurrence score and locoregional recurrence in node-positive/ER-positive breast cancer treated with chemo-endocrine therapy. J Natl Cancer Inst. 109(4), 2017
Nichol AM et al: The Use of Hormone Therapy Alone Versus Hormone Therapy and Radiation Therapy for Breast Cancer in Elderly Women: A Population-Based Study. Int J Radiat Oncol Biol Phys. 98(4):829-839, 2017
Shah S et al: A Single Institution Retrospective Comparison Study of Locoregional Recurrence After Accelerated Partial Breast Irradiation Using External Beam Fractionation Compared with Whole Breast Irradiation with 8 Years of Follow-Up. Ann Surg Oncol. 24(10):2935-2942, 2017
Teshome M et al: Breast conserving surgery and locoregional control after neoadjuvant chemotherapy. Eur J Surg Oncol. 43(5):865-874, 2017
Wilkinson JB et al: Outcomes According to Breast Cancer Subtype in Patients Treated With Accelerated Partial Breast Irradiation. Clin Breast Cancer. 17(1):55-60, 2017
Cox CE et al: A Prospective, Single Arm, Multi-site, Clinical Evaluation of a Nonradioactive Surgical Guidance Technology for the Location of Nonpalpable Breast Lesions during Excision. Ann Surg Oncol. 23(10):3168-74, 2016
De La Cruz L et al: Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients: A Systematic Literature Review. Ann Surg Oncol. 23(10):3247-58, 2016
Dryden MJ et al: Imaging Factors That Influence Surgical Margins After Preoperative 125I Radioactive Seed Localization of Breast Lesions: Comparison With Wire Localization. AJR Am J Roentgenol. 206(5):1112-8, 2016
Merrill AL et al: Implications of new lumpectomy margin guidelines for breast-conserving surgery: Changes in reexcision rates and predicted rates of residual tumor. Ann Surg Oncol. 23(3):729-34, 2016
Morrow M et al: Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ. Ann Surg Oncol. 23(12):3801-3810, 2016
Swisher SK et al: Locoregional control according to breast cancer subtype and response to neoadjuvant chemotherapy in breast cancer patients undergoing breast-conserving therapy. Ann Surg Oncol. 23(3):749-56, 2016
Urano M et al: Digital mammography versus digital breast tomosynthesis for detection of breast cancer in the intraoperative specimen during breast-conserving surgery. Breast Cancer. 23(5):706-11, 2016
Whitley MJ et al: A mouse-human phase 1 co-clinical trial of a protease-activated fluorescent probe for imaging cancer. Sci Transl Med. 8(320):320ra4, 2016
Chan BK et al: Localization techniques for guided surgical excision of non-palpable breast lesions. Cochrane Database Syst Rev. CD009206, 2015
Kunkler IH et al: Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 16(3):266-73, 2015
McCormick B et al: RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 33(7):709-15, 2015
Landercasper J et al: Reasons for re-excision after lumpectomy for breast cancer: insight from the American Society of Breast Surgeons Mastery(SM) database. Ann Surg Oncol. 21(10):3185-91, 2014
Moran MS et al: Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol. 21(3):704-16, 2014
Schnabel F et al: A randomized prospective study of lumpectomy margin assessment with use of MarginProbe in patients with nonpalpable breast malignancies. Ann Surg Oncol. 21(5):1589-95, 2014
Wilke LG et al: Repeat surgery after breast conservation for the treatment of stage 0 to II breast carcinoma: a report from the National Cancer Data Base, 2004-2010. JAMA Surg. 149(12):1296-305, 2014
Donker M et al: Breast-conserving treatment with or without radiotherapy in ductal carcinoma In Situ: 15-year recurrence rates and outcome after a recurrence, from the EORTC 10853 randomized phase III trial. J Clin Oncol. 31(32):4054-9, 2013
Down SK et al: Oncological advantages of oncoplastic breast-conserving surgery in treatment of early breast cancer. Breast J. 19(1):56-63, 2013
Hughes KS et al: Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 31(19):2382-7, 2013
Mittendorf EA et al: Impact of chemotherapy sequencing on local-regional failure risk in breast cancer patients undergoing breast-conserving therapy. Ann Surg. 257(2):173-9, 2013
Solin LJ et al: A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst. 105(10):701-10, 2013
Beitsch PD et al: Tumor bed control with balloon-based accelerated partial breast irradiation: incidence of true recurrences versus elsewhere failures in the American Society of Breast Surgery MammoSite(®) Registry Trial. Ann Surg Oncol. 19(10):3165-70, 2012
Degnim AC et al: A prospective study of breast lymphedema: frequency, symptoms, and quality of life. Breast Cancer Res Treat. 134(3):915-22, 2012
Arvold ND et al: Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy. J Clin Oncol. 29(29):3885-91, 2011
Darby S et al: Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707-16, 2011
Jeruss JS et al: Update on DCIS outcomes from the American Society of Breast Surgeons accelerated partial breast irradiation registry trial. Ann Surg Oncol. 18(1):65-71, 2011
Kronowitz SJ et al: A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects. Plast Reconstr Surg. 122(6):1631-47, 2008
Wahl AO et al: Multi-institutional review of repeat irradiation of chest wall and breast for recurrent breast cancer. Int J Radiat Oncol Biol Phys. 70(2):477-84, 2008
Cabioglu N et al: Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol. 14(4):1458-71, 2007
Boughey JC et al: Impact of preoperative versus postoperative chemotherapy on the extent and number of surgical procedures in patients treated in randomized clinical trials for breast cancer. Ann Surg. 244(3):464-70, 2006
Choi JY et al: Aesthetic and reconstruction considerations in oncologic breast surgery. J Am Coll Surg. 202(6):943-52, 2006
Kronowitz SJ et al: Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg. 117(1):1-11; discussion 12-4, 2006
Fisher B et al: Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 347(16):1233-41, 2002
Veronesi U et al: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 347(16):1227-32, 2002
Jackman RJ et al: Needle-localized breast biopsy: why do we fail? Radiology. 204(3):677-84, 1997
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
TERMINOLOGY
Synonyms
Partial or segmental mastectomy; lumpectomy
Definitions
Breast-conserving surgery (BCS): Excising malignancy with intent to obtain adequate margins, which, based on cancer location, may include pectoralis fascia or skin
Connotes removal of cancer with intention to cure
Term also applies to reexcision for clear margins
Breast-conserving therapy (BCT): BCS followed by radiation therapy (XRT)
Margins: Tissue surrounding cancer
Amount of benign tissue between edge of malignancy and edge of resection
Adequate margin for local control: No ink on tumor in invasive cancer; 2-mm margin for DCIS
Also used to connote additional tissue taken at lumpectomy edges, a.k.a. "cavity margins" if from all sides
Quadrantectomy (segmentectomy): Resection of triangular segment of breast (apex at nipple), including skin and pectoralis fascia
Based on segmental growth of cancer; used more often in European centers
Option for larger cancers with enough remaining breast; often requires oncoplastic closure for acceptable cosmetic result
Excisional biopsy: Removal of abnormality for diagnosis
Incisional biopsy: Removal of part of abnormality for diagnosis
Oncoplastic BCS
Cancer removed with wide margins to reduce positive margins and reexcision rates
Improves cosmetic outcomes, especially for larger tumors
Remaining breast tissue surgically reapproximated to achieve acceptable cosmetic result
Can result in breast asymmetry; may need reduction/lift of contralateral breast
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Expected Outcome
Things to Do
OUTCOMES
Complications
Selected References
Gray RJ et al: Intraoperative margin management in breast-conserving surgery: a systematic review of the literature. Ann Surg Oncol. 25(1):18-27, 2018
Arthur DW et al: NRG Oncology-Radiation Therapy Oncology Group Study 1014: 1-year toxicity report from a phase 2 study of repeat breast-preserving surgery and 3-dimensional conformal partial-breast reirradiation for in-breast recurrence. Int J Radiat Oncol Biol Phys. 98(5):1028-35, 2017
Correa C et al: Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract Radiat Oncol. 7(2):73-9, 2017
Jeffries DO et al: Localization for breast surgery: the next generation. Arch Pathol Lab Med. 141(10):1324-29, 2017
Mamounas EP et al: 21-gene recurrence score and locoregional recurrence in node-positive/ER-positive breast cancer treated with chemo-endocrine therapy. J Natl Cancer Inst. 109(4), 2017
Nichol AM et al: The Use of Hormone Therapy Alone Versus Hormone Therapy and Radiation Therapy for Breast Cancer in Elderly Women: A Population-Based Study. Int J Radiat Oncol Biol Phys. 98(4):829-839, 2017
Shah S et al: A Single Institution Retrospective Comparison Study of Locoregional Recurrence After Accelerated Partial Breast Irradiation Using External Beam Fractionation Compared with Whole Breast Irradiation with 8 Years of Follow-Up. Ann Surg Oncol. 24(10):2935-2942, 2017
Teshome M et al: Breast conserving surgery and locoregional control after neoadjuvant chemotherapy. Eur J Surg Oncol. 43(5):865-874, 2017
Wilkinson JB et al: Outcomes According to Breast Cancer Subtype in Patients Treated With Accelerated Partial Breast Irradiation. Clin Breast Cancer. 17(1):55-60, 2017
Cox CE et al: A Prospective, Single Arm, Multi-site, Clinical Evaluation of a Nonradioactive Surgical Guidance Technology for the Location of Nonpalpable Breast Lesions during Excision. Ann Surg Oncol. 23(10):3168-74, 2016
De La Cruz L et al: Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients: A Systematic Literature Review. Ann Surg Oncol. 23(10):3247-58, 2016
Dryden MJ et al: Imaging Factors That Influence Surgical Margins After Preoperative 125I Radioactive Seed Localization of Breast Lesions: Comparison With Wire Localization. AJR Am J Roentgenol. 206(5):1112-8, 2016
Merrill AL et al: Implications of new lumpectomy margin guidelines for breast-conserving surgery: Changes in reexcision rates and predicted rates of residual tumor. Ann Surg Oncol. 23(3):729-34, 2016
Morrow M et al: Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ. Ann Surg Oncol. 23(12):3801-3810, 2016
Swisher SK et al: Locoregional control according to breast cancer subtype and response to neoadjuvant chemotherapy in breast cancer patients undergoing breast-conserving therapy. Ann Surg Oncol. 23(3):749-56, 2016
Urano M et al: Digital mammography versus digital breast tomosynthesis for detection of breast cancer in the intraoperative specimen during breast-conserving surgery. Breast Cancer. 23(5):706-11, 2016
Whitley MJ et al: A mouse-human phase 1 co-clinical trial of a protease-activated fluorescent probe for imaging cancer. Sci Transl Med. 8(320):320ra4, 2016
Chan BK et al: Localization techniques for guided surgical excision of non-palpable breast lesions. Cochrane Database Syst Rev. CD009206, 2015
Kunkler IH et al: Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 16(3):266-73, 2015
McCormick B et al: RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 33(7):709-15, 2015
Landercasper J et al: Reasons for re-excision after lumpectomy for breast cancer: insight from the American Society of Breast Surgeons Mastery(SM) database. Ann Surg Oncol. 21(10):3185-91, 2014
Moran MS et al: Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol. 21(3):704-16, 2014
Schnabel F et al: A randomized prospective study of lumpectomy margin assessment with use of MarginProbe in patients with nonpalpable breast malignancies. Ann Surg Oncol. 21(5):1589-95, 2014
Wilke LG et al: Repeat surgery after breast conservation for the treatment of stage 0 to II breast carcinoma: a report from the National Cancer Data Base, 2004-2010. JAMA Surg. 149(12):1296-305, 2014
Donker M et al: Breast-conserving treatment with or without radiotherapy in ductal carcinoma In Situ: 15-year recurrence rates and outcome after a recurrence, from the EORTC 10853 randomized phase III trial. J Clin Oncol. 31(32):4054-9, 2013
Down SK et al: Oncological advantages of oncoplastic breast-conserving surgery in treatment of early breast cancer. Breast J. 19(1):56-63, 2013
Hughes KS et al: Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 31(19):2382-7, 2013
Mittendorf EA et al: Impact of chemotherapy sequencing on local-regional failure risk in breast cancer patients undergoing breast-conserving therapy. Ann Surg. 257(2):173-9, 2013
Solin LJ et al: A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst. 105(10):701-10, 2013
Beitsch PD et al: Tumor bed control with balloon-based accelerated partial breast irradiation: incidence of true recurrences versus elsewhere failures in the American Society of Breast Surgery MammoSite(®) Registry Trial. Ann Surg Oncol. 19(10):3165-70, 2012
Degnim AC et al: A prospective study of breast lymphedema: frequency, symptoms, and quality of life. Breast Cancer Res Treat. 134(3):915-22, 2012
Arvold ND et al: Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy. J Clin Oncol. 29(29):3885-91, 2011
Darby S et al: Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707-16, 2011
Jeruss JS et al: Update on DCIS outcomes from the American Society of Breast Surgeons accelerated partial breast irradiation registry trial. Ann Surg Oncol. 18(1):65-71, 2011
Kronowitz SJ et al: A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects. Plast Reconstr Surg. 122(6):1631-47, 2008
Wahl AO et al: Multi-institutional review of repeat irradiation of chest wall and breast for recurrent breast cancer. Int J Radiat Oncol Biol Phys. 70(2):477-84, 2008
Cabioglu N et al: Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol. 14(4):1458-71, 2007
Boughey JC et al: Impact of preoperative versus postoperative chemotherapy on the extent and number of surgical procedures in patients treated in randomized clinical trials for breast cancer. Ann Surg. 244(3):464-70, 2006
Choi JY et al: Aesthetic and reconstruction considerations in oncologic breast surgery. J Am Coll Surg. 202(6):943-52, 2006
Kronowitz SJ et al: Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg. 117(1):1-11; discussion 12-4, 2006
Fisher B et al: Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 347(16):1233-41, 2002
Veronesi U et al: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 347(16):1227-32, 2002
Jackman RJ et al: Needle-localized breast biopsy: why do we fail? Radiology. 204(3):677-84, 1997
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