***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: OBJECTIVE The purpose of this study was to evaluate the safety and performance of localizing nonpalpable breast lesions using radiofrequency identification technology . SUBJECTS AND METHODS Twenty consecutive women requiring preoperative localization of a breast lesion were recruited . Subjects underwent placement of both a hook wire and a radiofrequency identification tag immediately before surgery . The radiofrequency identification tag was the primary method used by the operating surgeon to localize each lesion during excision , with the hook wire serving as backup in case of tag migration or failed localization . Successful localization with removal of the intended lesion was the primary outcome measured . Tag migration and postoperative infection were also noted to assess safety . RESULTS Twenty patients underwent placement of a radiofrequency identification tag , 12 under ultrasound guidance  and eight with stereotactic guidance .  In all cases , the radiofrequency identification tag  was successfully localized by the reader at the level of the skin before incision , and the intended lesion was removed along with the radiofrequency identification tag . There were no localization failures and no postoperative infections . Tag migration did not occur before incision , but in three cases , occurred as the lesion was being retracted with fingers to make the final cut along the deep surface of the specimen . CONCLUSION In this initial clinical study , radiofrequency tags were safe and able to successfully localize nonpalpable breast lesions . Radiofrequency identification technology may represent an alternative method to hook wire localization 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 Wide  local excision ( WLE ) is a common surgical intervention for solid tumors such as those in melanoma , breast , pancreatic , and gastrointestinal cancer . However , adequate margin assessment during WLE remains a significant challenge , result ing in surgical re interventions to achieve adequate local control . Currently , no label-free imaging method is available for surgeons to examine the resection bed in vivo for microscopic residual cancer . Optical coherence tomography ( OCT ) enables real-time high-resolution imaging of tissue microstructure . Previous studies have demonstrated that OCT analysis of excised tissue specimens can distinguish between normal and cancerous tissues by identifying the heterogeneous and disorganized microscopic tissue structures indicative of malignancy . In this translational study involving 35 patients , a h and held surgical OCT imaging probe was developed for in vivo use to assess margins both in the resection bed and on excised specimens for the microscopic presence of cancer . The image results from OCT showed structural differences between normal and cancerous tissue within the resection bed following WLE of the human breast . The ex vivo images were compared with st and ard postoperative histopathology to yield sensitivity of 91.7 % [ 95 % confidence interval ( CI ) , 62.5%-100 % ] and specificity of 92.1 % ( 95 % CI , 78.4%-98 % ) . This study demonstrates in vivo OCT imaging of the resection bed during WLE with the potential for real-time microscopic image-guided surgery BACKGROUND This r and omized , double-arm trial was design ed to study the benefit of a novel device ( MarginProbe , Dune Medical Devices , Caesarea , Israel ) in intraoperative margin assessment for breast-conserving surgery ( BCS ) and the associated reduction in reoperations . METHODS In the device group , the probe was applied to the lumpectomy specimen and additional tissue was excised according to device readings . Study arms were compared by reoperation rates and by correct surgical reaction confirmed by histology . RESULTS Three hundred patients were enrolled . Device use was associated with improved correct surgical reaction , defined as additional re-excision in all histologically detected positive margins , with tumor within 1 mm of inked margin . The repeat lumpectomy rate was significantly reduced by 56 % in the device arm : 5.6 % versus 12.7 % in the control arm . There were no differences in excised tissue volume or cosmetic outcome . CONCLUSIONS Intraoperative use of the MarginProbe for positive margin detection is safe and effective in BCS and decreases the rate of repeat operations Background Breast carcinoma is the most frequently diagnosed malignancy in women of the North America . The combination of breast-conservation surgery and radiotherapy has become a st and ard of treatment for most breast cancers . It is critical to obtain clear margins to minimize local recurrence . The literature suggests that intraoperative touch preparation cytology ( IOTPC ) can be useful in evaluation of margins . Invasive lobular carcinoma ( ILC ) accounts for 10 % to 15 % of all breast cancers . Obtaining clear margins in ILC can be more challenging . Literature shows the positive margin rate for ILC to be as high as 60 % . This report describes our experience with IOTPC for margin assessment in ILC by a single surgeon at Beth Israel Medical Center . The purpose of this study is to determine whether IOTPC is reliable for ILC . Methods A prospect i ve review of 73 patients who underwent breast-conservation surgery with the use of IOTPC for margin assessment at Beth Israel Medical Center was performed . Pathology revealed ILC in 12 of these patients ( 16.4 % ) , who are the subjects of this study . The lumpectomy specimens were oriented by the surgeon intraoperatively and were su bmi tted fresh to pathology for cytologic assessment . IOTPC consisted of touching the corresponding margin onto the glass slide . The principle of this technique is that if cancer cells are present , they will stick to the slide , whereas fat cells will not . Six slides were prepared for each lumpectomy specimen . Air-dried sample s were stained immediately by the Diff-Quik method and examined under the microscope by a cytopathologist . Results Twelve patients with ILC underwent breast-conservation surgery with IOTPC for assessment of 72 margins . Ten patients had lobular carcinoma only , and the remaining two patients had a combination of lobular and ductal carcinoma . There was a correlation between IOTPC and final pathology in 60 of 72 margins , which accounted for 83.3 % of the cases . IOTPC for assessment of margins in patients undergoing breast-conservation surgery for ILC has a sensitivity of 8.3 % , specificity of 98.3 % , positive predictive value of 50 % , and negative predictive value of 84.3 % . Conclusions On the basis of our experience , IOTPC is of limited value for intraoperative assessment of margins for ILC 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 
    Output:
    
Results Ultrasound-guided lumpectomy for palpable tumors , as an alternative to palpation guidance , can lower positive margin rates , but the effect when used as an alternative to wire localization ( WL ) for nonpalpable tumors is less certain .
Localization techniques such as radioactive seed localization and radioguided occult lesion localization were found potentially to lower positive margin rates as alternatives to WL depending on baseline positive margin rates .
Intraoperative pathologic methods including gross histology , frozen section analysis , and imprint cytology all have the potential to lower the rates of positive margins .
Cavity-shave margins and the Marginprobe device both lower rates of positive margins , with some potential for negative cosmetic effects .
Specimen radiography and multiple miscellaneous techniques did not affect positive margin rates or provided too little evidence for formation of a conclusion .
Conclusions A systematic review of the literature showed evidence that several intraoperative techniques and actions can lower the rates of positive margins .