Surgical Margin Assessment in Breast-Conserving Therapy

Ensuring tumour-free margins in breast-conserving therapy is critical to minimise local recurrence while preserving breast appearance and patient quality of life. Surgical margin assessment involves evaluation of the resected specimen’s edges to confirm complete removal of cancerous tissue. Traditional approaches rely on postoperative histopathology, leading to a 15–30 % re-excision rate when margins are found to be positive or close. Intraoperative techniques have been developed to address this challenge, ranging from specimen radiography and frozen section analysis to emerging optical and spectroscopic methods. Recent advances integrate real-time imaging and computational analysis to guide surgeons during the primary procedure, reducing the need for subsequent operations. Global adoption of these technologies is driven by the potential to improve patient outcomes, decrease healthcare costs and standardise surgical practice across diverse clinical settings. Practical applications include handheld scanners, automated margin detectors and artificial intelligence–assisted imaging platforms, each offering trade-offs between speed, accuracy and resource requirements. Together, these innovations aim to achieve the dual goals of oncological safety and cosmetic preservation in breast-conserving therapy.

Research from Nature Portfolio

A foundational study demonstrated the feasibility of a three-dimensional margin scanner based on Raman spectroscopy that can rapidly map the entire surface of a resected specimen. By analysing molecular vibrational signatures, the device provided automated, image-guided feedback on tumour presence with high spatial resolution. Trials on phantom models and excised prophylactic specimens indicated potential for real-time margin assessment within clinically acceptable timescales, paving the way for a single-procedure approach and reduced re-excision rates.

Surgical Margin Assessment in Breast-Conserving Therapy publication trend

The graph below shows the total number of articles in surgical margin assessment in breast-conserving therapy across all publications each year (not limited to Nature Index journals).

Technical terms

Surgical margin: boundary of excised tissue assessed to ensure no residual tumour remains.

Positive margin: presence of cancer cells at the cut edge, indicating incomplete excision.

Re-excision: additional surgery undertaken to achieve clear margins after initial resection.

Raman spectroscopy: optical method that identifies molecular composition through vibrational fingerprints of tissue.

Differential ion mobility spectrometry (DMS): gas-phase ion separation technique used to classify tissue types via surgical smoke analysis.

Deep learning segmentation: use of neural network models to automatically delineate tumour boundaries in medical imaging.

References

1. Reducing re-excision rates in breast conserving surgery with Margin Probe: systematic review. British Journal of Surgery (2023).
2. The effect of energy modality on tissue identification from surgical smoke by differential ion mobility spectrometry. Microchemical Journal (2024).
3. Toward Intraoperative Margin Assessment Using a Deep Learning-Based Approach for Automatic Tumor Segmentation in Breast Lumpectomy Ultrasound Images. Cancers (2023).
4. Review of methods for intraoperative margin detection for breast conserving surgery. Journal of Biomedical Optics (2018).
5. Emerging Technologies for Real‐Time Intraoperative Margin Assessment in Future Breast‐Conserving Surgery. Advanced Science (2020).
6. Evaluating feasibility of an automated 3-dimensional scanner using Raman spectroscopy for intraoperative breast margin assessment. Scientific Reports (2017).