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 al1mm clearance from the inked margin Patterson et al2mm clearance from the inked margin Obedian et al

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 SchnittObedian Negative0 %2.2 % Close4 %2.1 % Focally positive6 %9.1 % Positive21 %13.2 %

Margin evaluation in BCT JCRT experience ILRDistant metastasis Negative7%25% Close Focally positive14%28% Positive28%35%

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