***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: With the increasing use of magnetic resonance imaging ( MRI ) , the physician is more frequently confronted with nonpalpable breast lesions that are only visible on MRI . In these cases , it is often difficult to obtain adequate material for pathological examination . One of the methods that may be performed is excisional biopsy after MRI-guided wire localization . This study intends to examine the feasibility and added benefit of this method . It appears to be a reliable and useful tool that is , therefore , of additional benefit to surgical practice Background Few published studies have shown the benefits of intraoperative ultrasound in avoiding inadequate margins in breast-conserving surgery . The aim of this study is to quantify  intraoperative ultrasound margin size and assess its relationship to tumor size , multifocality , palpability , histology , and presence of intraductal component . Methods Patients with breast cancer undergoing breast-conserving surgery in whom the operating surgeon visualized the tumor by ultrasound were included .  Ultrasound margins measured intraoperatively were prospect ively recorded and compared with pathology margins . Results Forty-five patients with 48 tumors were included . Twenty five patients ( 56 % ) had palpable tumors . Pathologic mean tumor size was 1.9 cm [ 95 % confidence interval ( CI ) 1.6–2.2 cm , range 0.5–4.8 cm ] . There was good correlation between closest margins recorded by ultrasound and pathology margins ( r = 0.4674 , P < 0.0008 ) . Fourteen patients ( 31 % ) had margins re-excised intraoperatively , 12 of them in the direction of the closest pathological margin . Three patients ( 7 % ) , all of whom had intraoperative re-excision , had a second operation for involved margins without residual cancer on pathological examination of the reoperative specimens . Ultrasound margins ≥0.5 cm achieved adequate pathology margins of ≥0.2 cm in 95 % of margins . Overestimation of pathology margins by ultrasound measurement was significantly affected by multifocality ( P = 0.0473 ) . Tumor size , palpability , invasive lobular histology , and presence of ductal carcinoma in situ ( DCIS ) did not cause significant overestimation of pathology margins  by ultrasound . Conclusions Intraoperative ultrasound may help maintain a low level of reoperation after breast-conserving surgery . Ultrasound margins < 0.5 cm should be re-excised intraoperatively . Reliability of ultrasound in predicting the closest pathology margins was diminished in patients with multifocal tumors Abstract Background : Wire localization ( WL ) is the current st and ard for surgical diagnosis of nonpalpable breast lesions . Many disadvantages inherent to WL are solved with radioactive seed localization ( RSL ) . This trial investigated the ability of RSL to reduce the need for specimen radiographs and operating room delays associated with WL . Methods : A total of 134 women were entered onto an institutional review board – approved study . RSL was performed by placing a titanium seed containing .29 to 20 mCi of iodine-125 to within 1 cm of the suggestive breast lesion . The surgeon used a h and held gamma detector to locate and excise the iodine-125 seed and the lesion . Results : Specimen radiographs were eliminated in 98 ( 79 % ) of 124 patients . Surgical seed retrieval was 100 % in 124 patients . No seed migration occurred after correct radiographical placement . A total of 26 ( 21 % ) of 124 patients required a specimen radiograph ; 22 ( 85 % ) of these 26 were performed for microcalcifications . Conclusions : After surgical removal , RSL can eliminate specimen radiographs when the radiologist accurately places the seed and the pathologist grossly identifies the lesion . If small microcalcifications are noted before surgery , then specimen radiographs may be necessary . RSL reduced requirements for specimen radiographs , decreased OR time , improved incision placement , and improved resections to clear margins Background The wire-guided excision of nonpalpable breast cancer often results in tumor resections with inadequate margins . This prospect i ve , r and omized trial was undertaken to investigate whether intraoperative ultrasound ( US ) guidance enables a better margin clearance than the wire-guided technique in the breast-conserving treatment of nonpalpable breast cancers . Methods Patients with a preoperative histological diagnosis of nonpalpable breast cancer that could be visualized both with US and mammography were included . Patients were r and omized to undergo either a wire-guided or a US-guided excision . Adequate margins were defined as ≥1 mm . Results Of 49 included patients , 23 were assigned to undergo wire-guided excision and 26 to undergo US-guided excision . One patient crossed over to US-guided excision after inadvertent wire displacement . Mean tumor diameter , specimen weight , and operating time were similar in both groups . The excision was adequate in 24 ( 89 % ) of 27 US-guided excisions and 12 ( 55 % ) of 22 wire-guide excisions ( P=.007 ) . Conclusions US-guided excision seems to be superior to wire-guided excision with respect to margin clearance of mammographically detected and US-visible nonpalpable breast cancers . Patients do not have to undergo the unpleasant wire placement before surgery BACKGROUND Routine resection of cavity shave margins ( additional tissue circumferentially around the cavity left by partial mastectomy ) may reduce the rates of positive margins ( margins positive for tumor ) and reexcision among patients undergoing partial mastectomy for breast cancer . METHODS In this r and omized , controlled trial , we assigned , in a 1:1 ratio , 235 patients with breast cancer of stage 0 to III who were undergoing partial mastectomy , with or without resection of selective margins  , to have further cavity shave margins resected ( shave group ) or not to have further cavity shave margins resected ( no-shave group ) . R and omization occurred intraoperatively after surgeons had completed st and ard partial mastectomy . Positive margins were defined as tumor touching the edge of the specimen that was removed in the case of invasive cancer and tumor that was within 1 mm of the edge of the specimen removed in the case of ductal carcinoma in situ . The rate of positive margins was the primary outcome measure ; secondary outcome measures included cosmesis and the volume of tissue resected . RESULTS The median age of the patients was 61 years ( range , 33 to 94 ) . On final pathological testing , 54 patients ( 23 % ) had invasive cancer , 45 ( 19 % ) had ductal carcinoma in situ , and 125 ( 53 % ) had both ; 11 patients had no further disease . The median size of the tumor in the greatest diameter was 1.1 cm ( range , 0 to 6.5 ) in patients with invasive carcinoma and 1.0 cm ( range , 0 to 9.3 ) in patients with ductal carcinoma in situ . Groups were well matched at baseline with respect to demographic and clinicopathological characteristics . The rate of positive margins after partial mastectomy ( before r and omization ) was similar in the shave group and the no-shave group ( 36 % and 34 % , respectively ; P=0.69 ) . After r and omization , patients in the shave group had a significantly lower rate of positive margins than did those in the no-shave group ( 19 % vs. 34 % , P=0.01 ) , as well as a lower rate of second surgery for margin clearance ( 10 % vs. 21 % , P=0.02 ) . There was no significant difference in complications between the two groups . CONCLUSIONS Cavity shaving halved the rates of positive margins and reexcision among patients with partial mastectomy . ( Funded by the Yale Cancer Center ; Clinical Trials.gov number , NCT01452399 . ) The role of cavity shaves in reducing re-excision rates in breast conserving surgery ( BCS ) remains unclear . We compared rates of close margins and re-excision following cavity shaves based on either intraoperative radiology or systematic cavity shaves . Data was recorded prospect ively from 1999 to 2003 for 217 patients undergoing BCS . For the first 106 cases , cavity shaves were performed when intraoperative radiological margins appeared close ( < 10 mm ) . The remaining 111 cases had systematic superior and inferior cavity shaves ( SSICS ) .  Close margins and re-excision rates were compared between groups . The median weight of excised tissue was less in group two : 82.8 g versus 100.5 g , P=0.001 . SSICS reduced close margins by 83 % ( 18/106 versus 8/111 ) , OR 0.17 , 95 % CI 0.08 - 0.48 , P=0.001 . Multivariate analysis showed SSICS also reduced re-excision rates ( 15 versus 8 cases ) , OR 0.26 , 95 % CI 0.09 - 0.74 , P=0.012 . SSICS reduces close margins and re-excision rates . This approach has additional cosmetic benefits because less tissue is excised Background Studies suggest radioguided seed localization ( RSL ) yields fewer positive margins than wire-guided localization ( WL ) . The goal of this study is to determine whether RSL is superior to WL . Methods Women with confirmed invasive or ductal carcinoma in situ ( DCIS ) undergoing localization and breast conserving surgery were enrolled . Outcomes measured include positive margin and reoperation rates , specimen weight , operative and localization times , and surgeon and radiologist ranking of procedural difficulty . Results R and omization was central ized , concealed , and stratified by surgeon with 153 patients in the WL group and 152 in RSL group . Localizations were performed using either ultrasound ( 70 % ) or mammographic guidance ( 30 % ) . Pathology was either DCIS ( 18 % ) or invasive carcinoma ( 82 % ) . Procedures were performed at 3 sites , by 7 surgeons . Only difference found for patient and tumor characteristics was more multifocal disease in RSL group . Using intention-to-treat analysis , there were no differences in positive margins rates for RSL ( 10.5 % ) and WL ( 11.8 % ) , ( P = .99 ) or for positive or close margins ( < 1 mm ) ( RSL 19 % and WL 22 % ; P = .61 ) . Mean operative time ( minutes ) was shorter for RSL ( RSL 19.4 vs WL 22.2 ; P < .001 ) . Specimen volume , weight , reoperation and localization times were similar . Surgeons ranked the seed technique as easier ( P = .008 ) , while radiologists ranked them similarly . Patient ’s pain rankings during wire localization were higher ( P = .038 ) . Conclusions In contrast to other trials positive margin and reoperation rates were similar for RSL and WL . However , for RSL  operative times were shorter , and the technique was preferred by surgeons , making it an acceptable method for localization Objective : To develop an intraoperative method for margin status evaluation during breast conservation therapy ( BCT )  using an automated analysis of imprint cytology specimens . Study Design : Imprint cytology sample s were prospect ively taken from 47 patients undergoing either BCT or breast reduction surgery . Touch preparations from BCT patients were taken on cut sections through the tumor to generate positive margin controls . For breast reduction patients , slide imprints were taken at cuts through the center of excised tissue . Analysis results from the presented technique were compared against st and ard pathologic diagnosis . Slides were stained with cytokeratin and Hoechst , imaged with an automated fluorescent microscope , and analyzed with a fast algorithm to automate discrimination between epithelial cells and noncellular debris . Results : The accuracy of the automated analysis was 95 % for identifying invasive cancers compared against final pathologic diagnosis . The overall sensitivity was 87 % while specificity was 100 % ( no false positives ) . This is comparable to the best reported results from manual examination of intraoperative imprint cytology slides while reducing the need for direct input from a cytopathologist . Conclusion : This work demonstrates a proof of concept for developing a highly accurate and automated system for the intraoperative evaluation of margin status to guide surgical decisions and lower positive margin rates Lumpectomy specimens are commonly divided into six sides : superficial , deep , superior , inferior , medial , and lateral . Orienting stitches are placed on the specimen during surgery to allow reorientation by pathology . Despite those efforts , specimen disorientation may occur . The aim of this study was to assess the correlation in orientation between surgeons and pathologists .  Lumpectomy specimens  were routinely oriented . An additional Prolene suture was r and omly placed by the surgeon on one side to be localized by pathology . The results were recorded and the disorientation rate calculated . Specimen size and presence of skin and /or muscle were also recorded . There were 122 lumpectomy specimens prospect ively entered . Average specimen volume was 95.5 cm3 . Twenty-four specimens had segments of skin or muscle . The additional sutures were evenly divided between the six sides . The overall disorientation rate was 31.1 % ( 95 % confidence interval , 23.1–40.2).The side-specific disorientation rates were 43 % , 40 % , 35 % , 29 % , 28 % , and 14 % 
    Output:
    
Conclusions A practical approach to performance improvement was used by the American Society of Breast Surgeons to create a toolbox of options to reduce lumpectomy reoperations and improve cosmetic outcomes