Minimizing re-excision after breast conserving surgery – a review of radiofrequency spectroscopy for real-time, intraoperative margin assessment

ABSTRACT

Introduction

For early-stage breast cancer, breast-conserving surgery (BCS) plus radiation is standard-of-care. Nationwide, >20% of BCS patients require re-excision for positive margins, resulting in delayed adjuvant therapy, increased complications, emotional and financial stress for patients, and additional cost to the healthcare system. Although several methods may be employed to mitigate positive margins, no technique can fully address the need. MarginProbe® is an adjunctive tool for real-time intraoperative margin assessment and is shown to reduce positive margins by >50%.

Areas Covered

Discussion of the impact of re-excision following BCS, a review of currently available methods for intraoperative margin management, followed by a technology and literature review of the MarginProbe® Radiofrequency Spectroscopy System.

Expert Opinion

Re-excision significantly impacts patients, providers and payers. Limitations in the ability to assess margins at time of surgery warrant more advanced methods of residual disease detection. MarginProbe facilitates the most efficient pathway for breast cancer patients through the surgical phase of treatment. The device is well-suited for adoption as the healthcare focus shifts from volume to value and supports the three pillars of the US Department of Health and Human Services’ ‘Triple-Aim’ strategy: improve population health, improve patient experience of care, and reduce per-capita costs.

KEYWORDS:

• BCS
• breast cancer
• breast conserving surgery
• MarginProbe®
• margins
• radiofrequency spectroscopy
• re-excision
• reoperation

Article highlights

• 20% patients receiving breast-conserving surgery for early-stage breast cancer must return for subsequent surgery due to positive margins, with wide variability amongst surgeons

• Re-excision surgery delays adjuvant cancer treatment, increases surgical complications, places additional emotional and financial stress on patient, and adds an estimated $690 million per year in preventable healthcare costs in the United States

• Multiple methods may be employed to mitigate positive margins at the time of surgery; however, no technique can fully address the need

• MarginProbe Radiofrequency Spectroscopy System is FDA approved for intraoperative margin assessment as an adjunct to standard of care and has been proven to reduce positive margins by 50% or more

• Wide-spread adoption of the device has the potential to improve outcomes, minimize variability, improve quality and patient satisfaction, and significantly reduce cost to the healthcare system

Disclosure statement

Dr. Reid received an honorarium for a MarginProbe speaking engagement March 2021. Dr. Falk received an honorarium for a MarginProbe speaking engagement February 2021. L. Cadena is the Director of Training and Medical Education and a salaried employee of Dilon Technologies, Inc., the company that manufactures and markets the MarginProbe. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.