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Efficacy of Intraoperative Widening of Surgical Resection Margins for Non-Palpable Breast Cancer: An Analysis of 771 Breast-Conserving Surgeries
by
, , , ,
Virginia Casati
1,†
,
Clémence Aellen
2,†,
Elisa Ramazzotti
1,
Camilla Favero
3,
Marcel Kapahnke
3,
Roberta Decio
4,
Claudia Canonica
3,4,
Nickolas Peradze
4,
Simone Schiaffino
2,5,6,
Diana Spinelli
5,6,
Carola Mia Laura Catanese
5,6,
Angela Lia Scarano
5,6,
Ulrike Perriard
7,
Meltem Yenigün
4 and
Maria Luisa Gasparri
1,2,3,4,*
1
Department of Gynecology and Obstetrics, EOC, Ospedale Civico, 6900 Lugano, Switzerland
2
Faculty of Biomedical Science, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
3
Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Ospedale Regionale di Bellinzona e Valli, San Giovanni, 6500 Bellinzona, Switzerland
4
Centro di Senologia della Svizzera Italiana (CSSI), Ospedale Regional di Lugano, 6900 Lugano, Switzerland
5
Istituto Imaging della Svizzera Italiana (IIMSI), EOC, 6500 Bellinzona, Switzerland
6
Centro di Radiologia e Senologia Luganese, 6900 Lugano, Switzerland
7
Istituto Cantonale di Patologia (ICP), 6600 Locarno, Switzerland
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work
Cancers 2025, 17(23), 3827; https://doi.org/10.3390/cancers17233827 (registering DOI)
Submission received: 29 July 2025
/
Revised: 6 November 2025
/
Accepted: 12 November 2025
/
Published: 28 November 2025
(This article belongs to the Special Issue Advanced Surgical Modalities in Breast Cancer Treatment)
Simple Summary
The incidence of non-palpable breast cancer is rising. Breast-conserving surgery (BCS) followed by radiation therapy is the standard of care for most of the patients with breast cancer. The aim of breast-conserving surgery is to obtain a successful excision of the intended lesion with tumor-free resection margins. At the same time, goal of the procedure is to remove less healthy tissue as possible to obtain better cosmetic outcomes. Various techniques are available for lesion marking and intraoperative margin assessment. This study investigates the role of intraoperative widening of selected surgical resection margins (IWSM) in wire-guided BCS. IWSM is a simple, reproducible approach that may contribute to reducing positive margin rates in the surgical treatment of non-palpable breast tumors, with a minimal impact on the final resected volume .
Abstract
Background: The aim of the implementation of preoperative marking procedures in non-palpable breast cancer is to obtain a successful excision of the intended lesion with tumor-free resection margins while removing as little as possible of the surrounding healthy breast tissue to better preserve cosmetic integrity. Based on the intraoperative X-ray of the tumor specimen, intraoperative widening of selected surgical resection margins (IWSM) can be performed to decrease the positive margin rate. This study aims to evaluate the role of IWSM in breast-conserving surgery. Methods: All patients undergoing guidewire localized conservative surgery for non-palpable breast cancers were considered for the study. Patients, tumor characteristics, and pathological findings were collected. Tumor specimens undergoing intraoperative X-ray were considered for the analysis. The number of IWSM specimens, the IWSM specimens containing tumor cells at final histology, and the volume of IWSM specimens were calculated. Results: Data from 771 tumorectomies for non-palpable breast cancer performed between 2017 and 2023 at the Centro di Senologia della Svizzera Italiana (CSSI) were collected. A total of 751 tumorectomies with intraoperative X-ray assessment of the margin’s status were included. In 461/751 cases (61.4%), at least one IWSM specimen was obtained. At the final histopathology, in 354/461 IWSM specimens (76.8%), no tumor cells were reported, while they were reported in 107/461 (23.2%). Of these, 89/107 (83.2%) had overall negative margins, while 18/107 (16.8%) presented involved margins at the final histopathology. In 323/461 (70.1%) IWSM specimens, the pathological report provided three dimensions useful for volume calculation. The mean volume of these specimens was 9 ± 15 cm3. Conclusions: IWSM can help increase the efficacy of tumorectomies for non-palpable breast cancer lesions. However, in the majority of cases, healthy breast tissue is removed as well. Tumor and patient characteristics may help in the selection of cases for which IWSM reduces the positive margin rate and the number of unnecessary procedures.
