***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: 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 . ) Positive margins and the result ing multiple operations are a major problem for breast conservation therapy . Accurate assessment of intraoperative tumor margins can limit multiple re-excision procedures . Intraoperative touch preparations have been used in the past but can be difficult to interpret without an experienced cytopathologist . The objective of this study is to examine the reliability of enhanced  intraoperative touch preps ( EIOTP ) compared with final pathologic margins . We prospect ively performed EIOTP on 20 tumors in women undergoing breast conservation therapy .  Six margins and the main tumor were touched onto poly-L-lysine coated slides . The slides were stained with anti MUC1 and anti-E-cadherin antibodies , and Hoechst nuclear stain . A parallel set of slides were stained with hematoxylin and eosin for comparison . The EIOTP results were compared with pathologic interpretation of paraffin embedded permanent sections . A total of 120 margins underwent EIOTP in 20 patients . We found a sensitivity equal to 80 per cent , specificity 100 per cent , positive predictive value 100 per cent , and negative predictive value 99 per cent . EIOTP in conjunction with MUC-1 and E-cadherin by immunofluorescence is a sensitive and highly specific mechanism to identify cancer cells at breast tissue margins . The immunofluorescence stains may help the pathologist to identify cancer cells in fresh breast tissue and limit breast re-excisions in the future Local recurrence in breast cancer surgery is related to the completeness of excision . Histological analysis of excision margins is time consuming and impractical for use intra-operatively . Our group evaluated breast imprint and scrape cytology ( ISC ) for the assessment of excision margins in a feasibility study in 1993 - 4 , with 10 year clinical follow-up . Twenty-six consecutive women undergoing 27 wide local excisions for breast cancer had excision margins prospect ively assessed with intra-operative ISC blinded to histology . All ISC results were ready ( range 22 - 30 min ) before surgery was completed . ISC agreed with histology in 21/27 ( = 78 % ) and disagreed in 6/27 ( = 22 % ) of the cases . In two cases with local recurrence , histology was positive in one case , whereas ISC margins were positive in both . Intra-operative ISC is reliable and could help the surgeon to excise more tissue to prevent a second ( re-excision ) operation . ISC margins may predict clinical outcome , although a larger interventional follow-up study is required Purpose Reexcision is a clinical ly relevant aspect of oncological breast conservation surgery . The influence of reexcision on aesthetic outcome is described differently in the literature . Our aim was to analyze this question in a well-defined cohort with st and ardized study instruments . Methods A total of 439 patients from a prospect ively followed cohort were included in this analysis . Aesthetic results were assessed by the Breast Cancer Treatment Outcome Scale ( BCTOS ) aesthetic status . Date s of assessment s were shortly after surgical interventions and before surgery . Group comparison was performed between patients with reexcisions  ( 80 cases ; 18 % ) and patients without reexcision  ( 359 cases ; 82 % ) . We considered variables of differing distribution between the two groups that could hypothetically influence BCTOS aesthetic status in a nonparametric analysis of covariance ( ANCOVA ) . Results The aesthetic status of patients with reexcisions  was found to be significantly worse than for patients with a single breast conservation surgery ( P < 0.0001 ) when tested by a nonparametric ANCOVA model . Because patients with reexcisions had more noninvasive tumors ( 25 % vs. 8 % , P = 0.0001 ) and tumors were larger in patients with reexcision ( P = 0.01 ) , we included these variables as possible covariates in the multivariate model . The model was adjusted for the BCTOS aesthetic status before and shortly after the first surgery . Conclusions Our findings suggest that reexcision in breast conservation surgery impairs aesthetic outcome , at least when assessed shortly after surgery In cases of wire-guided excision of non-palpable breast cancer ( WGE ) , data concerning the determinants and correlations between radiologic and histologic margins and residual cancer in re-excisions are sparse . A total of 21 variables in 66 WGE followed by 49 re-excisions were prospect ively analyzed . In multivariate analysis , only large mammographic lesions were clearly related to positive margins in specimen radiography ( P<0.05 ) . Multifocality ( P<0.001 ) , large pathologic size ( P<0.05 ) and superficial excision ( P<0.05 ) were related to positive histologic margins and multifocality ( P=0.001 ) to residual disease in re-excisions . The sensitivity , specificity and positive predictive values of specimen radiography for predicting histologic margins were 33 % , 79 % and 53 % , and those for predicting residual disease 30 % , 80 % and 38 % , respectively . The ability of histologic margins to predict residual disease was 91 % , 58 % and 38 % , respectively . In WGE , large mammographic lesions carry a significant risk for radiologically incomplete excision , while pathologically large and multifocal tumors may be histologically incompletely excised , especially if the excision does not extend down to the pectoral fascia . The excision sites of multifocal tumors should be re-excised because of the considerable risk of residual disease . The radiologic and histologic margins of the specimen may be misleading As breast cancer screening rates increase , smaller and more numerous lesions are being identified earlier , leading to more breast-conserving surgical procedures . Achieving a clean surgical margin represents a technical challenge with important clinical implication s. Optical coherence tomography ( OCT ) is introduced as an intraoperative high-resolution imaging technique that assesses surgical breast tumor margins by providing real-time microscopic images up to 2 mm beneath the tissue surface . In a study of 37 patients split between training and study groups , OCT images covering 1 cm(2 ) regions were acquired from surgical margins of lumpectomy specimens , registered with ink , and correlated with corresponding histologic sections . A 17-patient training set used to establish st and ard imaging protocol s and OCT evaluation criteria showed that areas of higher scattering tissue with a heterogeneous pattern were indicative of tumor cells and tumor tissue in contrast to lower scattering adipocytes found in normal breast tissue . The remaining 20 patients were enrolled into the feasibility study . Of these lumpectomy specimens , 11 were identified with a positive or close surgical margin and 9 were identified with a negative margin under OCT . Based on histologic findings , 9 true positives , 9 true negatives , 2 false positives , and 0 false negatives were found , yielding a sensitivity of 100 % and specificity of 82 % . These results show the potential of OCT as a real-time method for intraoperative margin assessment in breast-conserving surgeries BACKGROUND St and ard two-dimensional ( 2D ) specimen radiography may guide intraoperative re-excision of margins in patients undergoing breast conserving surgery . We sought to determine the impact of three-dimensional ( 3D ) specimen imaging in further reducing positive margin rates . METHODS A prospect i ve study of 100 patients in which both 2D and 3D specimen radiographies were performed . The impact of orthogonal view on intraoperative surgical management and final margins was assessed . RESULTS Ten patients had no residual tumor ; therefore , 90 patients formed the cohort of interest . Of them , 21 patients ( 23.3 % ) had ductal carcinoma in situ ; 18 ( 20.0 % ) had invasive cancer ; and 51 ( 56.7 % ) had both .  Median tumor size was 1.7 cm ( range , .2 to 8.1 cm ) . On the basis of 2D imaging , surgeons stated they would take more tissue in 26 patients ( 28.9 % ) . Three-dimensional imaging changed management in 4 patients ( 6.3 % ) . One of these patients would have had positive margins if the intraoperative resection done on the basis of the 3D imaging would have been omitted . CONCLUSIONS Three-dimensional specimen imaging results in further intraoperative re-excision in 6.3 % of patients and may reduce re-excision rates in 2.2 % Background The rate of reexcision in breast-conserving surgery remains high , leading to delay in initiation of adjuvant therapy , increased cost , increased complications 
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Conclusions : Pooled data suggest that frozen section and cytology have the greatest diagnostic accuracy .