HEALTH PROFESSIONAL · SOURCE READING

Surgical Staging of the Primary Tumor

Source: Breast Cancer Treatment (PDQ®)–Health Professional Version, National Cancer Institute.

Source updated: April 25, 2025 · Captured 2026-09-09.

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Context: Surgical Treatment for Breast Cancer

Selection of a local therapeutic approach depends on the following factors:[6]

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Location and size of the lesion.

Analysis of the mammogram and/or magnetic resonance imaging or additional imaging.

Breast size.

Patient’s desire to preserve the breast.

Options for surgical management of the primary tumor include:

Breast-conserving surgery (with consideration of radiation therapy). All histological types of invasive breast cancer may be treated with breast-conserving surgery plus radiation therapy.[7] However, the presence of inflammatory breast cancer, regardless of histological subtype, is a contraindication to breast-conserving therapy. The presence of multifocal disease in the breast and a history of collagen vascular disease are relative contraindications to breast-conserving therapy. Prior radiation to the breast was previously considered a contraindication to breast-conserving surgery. However, research has increasingly shown that repeat radiation therapy may be feasible and safe in select patient populations.[8]

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Mastectomy with or without breast reconstruction.

Survival is equivalent with any of these options, as documented in the EORTC-10801 trial [9] and other prospective randomized trials.[10-16] Also, a retrospective study of 753 patients who were divided into three groups based on hormone receptor status (ER positive or PR positive; ER negative and PR negative but HER2 positive; and triple negative) found no differences in disease control within the breast in patients treated with standard breast-conserving surgery; however, there are not yet substantive data to support this finding.[17]

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The rate of local recurrence in the breast after conservative treatment is low and varies slightly with the surgical technique used (e.g., lumpectomy, quadrantectomy, segmental mastectomy, and others). Whether completely clear microscopic margins are necessary has been debated.[18-20] However, a multidisciplinary consensus panel recently used margin width and ipsilateral breast tumor recurrence from a meta-analysis of 33 studies (N = 28,162 patients) as the primary evidence base for a new consensus regarding margins in patients with stage I and stage II breast cancer treated with breast-conserving surgery plus radiation therapy. Results of the meta-analysis include the following:[21]

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Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) were associated with a twofold increase in the risk of ipsilateral breast tumor recurrence compared with negative margins.

More widely clear margins were not found to significantly decrease the rate of ipsilateral breast tumor recurrence compared with no ink on tumor. Thus, it was recommended that the use of no ink on tumor be the new standard for an adequate margin in invasive cancer.

There was no evidence that more widely clear margins reduced ipsilateral breast tumor recurrence for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component.

For patients undergoing partial mastectomy, margins may be positive after primary surgery, often leading to re-excision. A clinical trial of 235 patients with stage 0 to III breast cancer who underwent partial mastectomy, with or without resection of selective margins, randomly assigned patients to have additional cavity shave margins resected (shave group) or not (no-shave group).[22] Patients in the shave group had a significantly lower rate of positive margins than those in the no-shave group (19% vs. 34%, P = .01) and a lower rate of second surgery for clearing margins (10% vs. 21%, P = .02).[22][Level of evidence B3]

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Preserved source evidence · Not medical advice