gms | German Medical Science

Ever since breast conserving therapy has been introduced in clinical practice the tumor free margin of the excised specimen plays an important role in terms of reoperations, local recurrence and long term survival. In the beginning a safety margin of at least 10mm was considered obligatory in our team for both in-situ and invasive carcinoma. According to the data of the Nottingham group the safety margin of at least 5mm seems sufficient in invasive breast carcinoma single lesion keeping the 10mm or more for non-invasive tumors. The aim of surgery as long as breast conserving therapy is suitable. The excision of a palpable tumor seems not to be a problem. But there are different ways of marking non palpable lesions within the breast. Until 2001 this would have been done preoperatively by radiography and placing a wire into the tumor (Group 1). From 2002 since most of the breast carcinomas can be detected by ultrasound imaging we started to detect the intramammary lesion after core needle biopsy confirmation of the diagnosis both by preoperative and intraoperative ultrasound scan in order to make sure that the desired tumor free margin is achieved (Group 2). This study was undertaken to confirm whether the latter treatment leads to a reduction of secondary operations. From 1995 to 2001 in the first group of 332 patients with breast carcinoma at stage T1 or T2 were treated by breast conserving therapy in our department after wire marking or by direct palpation. In 6,4% of the patients a second operation had to be performed because of a insufficient safety margin around the cancerous lesion. From 2002 to August 2005 another 324 patients suitable for breast conserving therapy were operated using preoperative ultrasound imaging performed together by the radiologist and the surgeon as well as intraoperative ultrasound imaging by the surgeon and postoperative control by the radiologist. Surgery was performed using special ceramic coated scissors under continuous ultrasound visualisation. The reoperation rate for insufficient tumor free margins dropped down to 1,5% in this group. A multidisciplinary approach with close links between preoperative diagnosis, intraoperative continuous detection of a breast carcinoma and control of the desired tumor free margin by ultrasound imaging and histopathology significantly lessens the need for reoperations. The latter seems to be a strong indicator for the quality of the operating sequence in early stage breast cancer treatment.