Surgical management of early breast cancer

The advent of screening mammography and its widespread application has resulted in more patients being diagnosed with small invasive breast cancers. Most of these early breast cancer patients can be treated with breast conservation surgery and sentinel lymphadenectomy followed by radiotherapy. Preoperative planning includes a tissue diagnosis of cancer before proceeding to surgery and assessment of whether the patient can receive radiotherapy. Surgical incisions used in breast conservation surgery should be placed such as to maximize cosmesis but not compromise a mastectomy, if one is needed. Surgeons should play an active role in inking the margins and assessing margin status intraoperatively. Shaved margins aid in obtaining negative margins. Sentinel lymphadenectomy for axillary evaluation has become the primary tool in axillary evaluation in patients with early breast cancers. Percutaneous ablation has been shown to adequately treat primary and metastatic disease in multiple organs, including the liver, kidneys, lungs, brain, and prostate. Questions regarding its applicability to breast cancer treatment have arisen over the past 2 decades. Although no large, randomized trials have been performed to assess the feasibility of replacing lumpectomy with percutaneous ablation in breast conserving therapy for early-stage breast cancer, a growing body of literature supports the safety and efficacy of percutaneous ablation and stresses the importance of undertaking such a trial.