Transcript Margin evaluation in Breast Conservation Treatment

Margin evaluation in Breast
Conservation Treatment
Dr. C. Gopalakrishnan Nair
Department of endocrine Surgery
College of Medicine
AIMS
Kochi, Kerala
These Power Point presentations are free to download only for academic
purposes, with due acknowledgements to authors and this website.
Criteria for BCT
• Capability to deliver breast irradiation
• Likelihood of achieving a cosmetically
acceptable result
• Ability to obtain margin negative lumpectomy
Margin evaluation in BCT
• Margin is characterised as the
closest microscopic distance
between the inked lumpectomy
tissue edge and any cancerous
tissue
Margin evaluation in BCT
• Operative practice is to have a
1 cm clearance
• Specimen is well oriented
Margin evaluation in BCT
• Gage and colleagues( JCRT)
• Schnit et al
1mm clearance from
the inked margin
• Patterson et al
• Obedian et al
2mm clearance from
the inked margin
Margin evaluation in BCT
•
•
•
•
Negative margin
Close margin
Focally positive margin
Positive margin
Margin evaluation in BCT
• Result of BCT stratified by extent of margin
Schnitt
Obedian
Negative
0%
2.2 %
Close
4%
2.1 %
Focally positive
6%
9.1 %
Positive
21 %
13.2 %
Margin evaluation in BCT
• JCRT experience
ILR
7%
Distant
metastasis
25%
Focally positive
14%
28%
Positive
28%
35%
Negative
Close
Margin evaluation in BCT
• New techniques to improve lumpectomy
margin
1. MRI
2.Intra-op ultrasound
Margin evaluation in BCT
• Intraoperative Margin analysis
1. Frozen section
2. Shave biopsy
3.Imprint cytology
Margin evaluation in BCT
• Preoperative needle biopsy
• Better to avoid surgical biopsy
Margin evaluation in BCT
• Pathological margin status and
adjuvant systemic therapy are the
most important associated features
with LR in BCT