Breast cancer is among the most prevalent malignancies affecting women worldwide. Breast conservation  surgery(BCS) is the preferred surgical treatment combined with radiation therapy for eligible early(EBC) and selected locally advanced breast cancer(LABC) patients (1). Achieving sound oncologic outcomes are of paramount importance. Preserving quality of life is pivotal too, with maintaining breast symmetry, shape, contour being crucial objectives. Oncoplastic breast surgery(OPS) techniques are believed to help achieving these goals to greater extent than conventional non-oncoplastic(nOPS) BCS (2).

After neoadjuvant chemotherapy (NACT), breast conservation surgery (BCS) remains a safe option even for large tumors and locally advanced breast cancer (LABC), although many patients may require oncoplastic procedures to achieve satisfactory cosmetic results (3). In settings where patients commonly present with large breast cancers or LABC, the benefits of BCS can be extended to a majority, aided by NACT, without compromising cure rates. Performing a post-NACT wide local excision (WLE) that extends beyond the marked pre-NACT margins can result in clear, uninfiltrated margins in 95% of cases. Conversely, relying on post-NACT margins alone to guide WLE may lead to infiltrated margins in 35% of patients, some of which could remain undetected, thereby increasing the risk of local recurrence (4). A novel method using sterile silver wire markers to delineate tumor margins has proven to be a safe, cost-effective, and practical approach, facilitating safe BCS in a substantial proportion of LABC patients. Additionally, the use of intraoperative frozen section histology (IFSH) enables oncologically complete BCS in a single step for most patients, offering significant cost savings by reducing the need for reoperations, and minimizing patient anxiety and delays in adjuvant treatment (5).

 REFERENCES:

1.      Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7-33.

2.       Morrow M, Li Y, Alderman AK, Jagsi R, Hamilton AS, Graff JJ, et al. Access to breast reconstruction after mastectomy and patient perspectives on reconstruction decision making. JAMA Surg. 2014;149(10):1015-21.

1.      Agarwal G, Sonthineni C, Mayilvaganan S, Mishra A, Lal P, Agrawal V. Surgical Outcomes of Primary Versus Post-Neoadjuvant Chemotherapy Breast Conservation Surgery: A Comparative Study from a Developing Country. World J Surg. 2018 May;42(5):1364-74.

2.      Aggarwal V, Agarwal G, Lal P, Krishnani N, Mishra A, Verma AK, Mishra SK. Feasibility study of safe breast conservation in large and locally advanced cancers with use of radiopaque markers to mark pre-neoadjuvant chemotherapy tumor margins. World J Surg. 2008 Dec;32(12):2562-9.

3.      Agarwal G, Sattavan S, Vishvak Chanthar KMM, Kumar A, Sabaretnam M, Chand G, Mishra A, Agrawal V. Cost-Efficacy Analysis of Use of Frozen Section Histology for Margin Assessment During Breast Conservation Surgery in Breast Cancer Patients. World J Surg. 2023 Oct;47(10):2457-63