***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: Purpose Wire localization has several disadvantages , notably wire migration and difficulty scheduling the procedure close to surgery . Radioactive seed localization overcomes these disadvantages , but implementation is limited due to radiation safety requirements . Magnetic seeds potentially offer the logistical benefits and transcutaneous detection equivalence of a radioactive seed , with easier implementation . This study was design ed to evaluate the feasibility and safety of using magnetic seeds for breast lesion localization . Methods A two-centre open-label cohort study to assess the feasibility and safety of magnetic seed ( Magseed ) localization of  breast lesions .  Magseeds were placed under radiological guidance into women having total mastectomy surgery . The primary outcome measure was seed migration distance . Secondary outcome measures included accuracy of placement , ease of transcutaneous detection , seed integrity and safety . Results Twenty-nine Magseeds were placed into the breasts of 28 patients under ultrasound guidance . There was no migration of the seeds between placement and surgery . Twenty-seven seeds were placed directly in the target lesion with the other seeds being 2 and 3 mm away . All seeds were detectable transcutaneously in all breast sizes and at all depths . There were no complications or safety issues . Conclusions Magnetic seeds are a feasible and safe method of breast lesion localization . They can be accurately placed , demonstrate no migration in this feasibility study and are detectable in all sizes and depths of breast tissue . Now that safety and feasibility have been demonstrated , further clinical studies are required to evaluate the seed ’s effectiveness in wide local excision surgery BACKGROUND If treatment of the axilla is indicated in patients with breast cancer who have a positive sentinel node , axillary lymph node dissection is the present st and ard . Although axillary lymph node dissection provides excellent regional control , it is associated with harmful side-effects . We aim ed to assess whether axillary radiotherapy provides comparable regional control with fewer side-effects . METHODS Patients with T1 - 2 primary breast cancer and no palpable lymphadenopathy were enrolled in the r and omised , multicentre , open-label , phase 3 non-inferiority EORTC 10981 - 22023 AMAROS trial . Patients were r and omly assigned ( 1:1 ) by a computer-generated allocation schedule to receive either axillary lymph node dissection or axillary radiotherapy in case of a positive sentinel node , stratified by institution . The primary endpoint was non-inferiority of 5-year axillary recurrence , considered to be not more than 4 % for the axillary radiotherapy group compared with an expected 2 % in the axillary lymph node dissection group . Analyses were by intention to treat and per protocol . The AMAROS trial is registered with Clinical Trials.gov , number NCT00014612 . FINDINGS Between Feb 19 , 2001 , and April 29 , 2010 , 4823 patients were enrolled at 34 centres from nine European countries , of whom 4806 were eligible for r and omisation . 2402 patients were r and omly assigned to receive  axillary lymph node dissection and 2404 to receive axillary radiotherapy . Of the 1425 patients with a positive sentinel node , 744 had been r and omly assigned to axillary lymph node dissection and 681 to axillary radiotherapy ; these patients constituted the intention-to-treat population . Median follow-up was 6·1 years ( IQR 4·1 - 8·0 ) for the patients with positive sentinel lymph nodes . In the axillary lymph node dissection group , 220 ( 33 % ) of 672 patients who underwent axillary lymph node dissection had additional positive nodes . Axillary recurrence occurred in four of 744 patients in the axillary lymph node dissection group and seven of 681 in the axillary radiotherapy group . 5-year axillary recurrence was 0·43 % ( 95 % CI 0·00 - 0·92 ) after axillary lymph node dissection versus 1·19 % ( 0·31 - 2·08 ) after axillary radiotherapy . The planned non-inferiority test was underpowered because of the low number of events . The one-sided 95 % CI for the underpowered non-inferiority test on the hazard ratio was 0·00 - 5·27 , with a non-inferiority margin of 2 . Lymphoedema in the ipsilateral arm was noted significantly more often after axillary lymph node dissection than after axillary radiotherapy at 1 year , 3 years , and 5 years . INTERPRETATION Axillary lymph node dissection and axillary radiotherapy after a positive sentinel node provide excellent and comparable axillary control for patients with T1 - 2 primary breast cancer and no palpable lymphadenopathy . Axillary radiotherapy results in significantly less morbidity . FUNDING EORTC Charitable Trust BACKGROUND There is controversy about whether breast conserving therapy ( BCT ) should be contraindicated in multifocal ( MF ) breast cancer . Few studies have reported on the oncologic safety of BCT in MF breast cancer . STUDY DESIGN We review ed a prospect i ve data base of 1,169 women with invasive breast cancer who were treated with segmentectomy and whole breast irradiation from 1991 through 2009 and followed at our institution . Multifocal breast cancer was defined as 2 or more distinct tumors excised with a single incision or segmentectomy . We compared 2 groups , MF and unifocal breast cancer patients , with respect to demographics , tumor characteristics , adjuvant systemic therapy , local recurrence ( LR ) , disease-free survival ( DFS ) , and overall survival ( OS ) . RESULTS One hundred sixty-four patients with MF and 999 with unifocal invasive breast cancer were treated with BCT . Median follow-up was 112 months . Compared with the unifocal group , patients in the MF group had higher 10-year LR ( 0.6 % vs 6.1 % , p < 0.001 ) and lower 10-year DFS ( 97.7 % vs 89.3 % , p < 0.001 ) and OS ( 98.4 % vs 85.8 % , p < 0.001 ) . On multivariable analysis , multifocality was independently significantly associated with local recurrence-free survival ( LRFS ) , DFS , and OS . CONCLUSIONS Our data suggest that BCT in MF breast cancer is oncologically safe but may result in a slightly inferior outcome compared with BCT in unifocal breast cancer 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 . ) Identifying molecular alterations in normal tissue adjacent to cancer is important for underst and ing cancer aetiology and design ing preventive measures . Here we analyse the DNA methylome of 569 breast tissue sample s , including 50 from cancer-free women and 84 from matched normal cancer pairs . We use statistical algorithms for dissecting intra- and inter- sample cellular heterogeneity and demonstrate that normal tissue adjacent to breast cancer is characterized by tens to thous and s of epigenetic alterations . We show that their genomic distribution is non-r and om , being strongly enriched for binding sites of transcription factors specifying chromatin architecture . We vali date the field defects in an independent cohort and demonstrate that over 30 % of the alterations exhibit increased enrichment within matched cancer sample s. Breast cancers highly enriched for epigenetic field defects , exhibit adverse clinical outcome . Our data support a model where clonal epigenetic reprogramming towards reduced differentiation in normal tissue is an important step in breast carcinogenesis Abstract Background The presence of tumor cells at the margins of breast lumpectomy specimens is associated with an increased risk of ipsilateral tumor recurrence . Twenty to 30 % of patients undergoing breast-conserving surgery require second procedures to achieve negative margins . This study evaluated the adjunctive use of the MarginProbe device ( Dune Medical Devices Ltd , Caesarea , Israel ) in providing real-time intraoperative assessment of lumpectomy margins . Methods This multicenter r and omized trial enrolled patients with nonpalpable breast malignancies . The study evaluated MarginProbe use in addition to st and ard intraoperative methods for margin assessment . After specimen removal and inspection , patients were r and omized to device or control arms . In the device arm , MarginProbe was used to examine the main lumpectomy specimens and direct additional excision of positive margins . Intraoperative imaging was used in both arms ; no intraoperative pathology assessment was permitted . Results In total , 596 patients were enrolled .  False-negative rates were 24.8 and 66.1 % and false-positive rates were 53.6 and 16.6 % in the device and control arms , respectively . All positive margins on positive main specimens were resected in 62 % ( 101 of 163 ) of cases in the device arm , versus 22 % ( 33 of 147 ) in the control arm ( p < 0.001 ) . A total of 19.8 % ( 59 of 298 ) of patients in the device arm underwent a reexcision procedure compared with 25.8 % ( 77 of 298 ) in the control arm ( 6 % absolute , 23 % relative reduction ) . The difference in tissue volume removed was not significant . Conclusions Adjunctive use of the MarginProbe device during breast-conserving surgery improved surgeons ’ ability to identify and resect positive lumpectomy margins in the absence of intraoperative pathology assessment , reducing the number of patients requiring reexcision . MarginProbe may aid performance of breast-conserving surgery by reducing the burden of reexcision procedures for patients and the health care system INTRODUCTION Multifocal breast cancer is associated with a higher risk of nodal involvement compared to unifocal breast cancer and the drainage pattern from multifocal localisations may be different . For this reason , the value of the sentinel node biopsy ( SNB ) procedure for this indication is debated . The aim of the current analysis was to evaluate the sentinel node identification rate and nodal involvement in patients with a multifocal tumour in the EORTC 10981 - 22023 AMAROS trial . PATIENTS AND METHODS From the first 4000 registered patients , 342 were identified with a multifocal tumour on histological examination and compared to a r and omly selected control group of 684 patients with a unifocal tumour . The outcome of the  SNB  was assessed . RESULTS The sentinel node was identified in 96 % of the patients with a multifocal tumour and in 98 % of those with unifocal disease . In the multifocal group , 51 % had a metastasis in the sentinel node compared to 28 % in the unifocal group ; and further nodal involvement after a positive sentinel node was found in 40 % ( 38/95 ) and 39 % ( 39/101 ) respectively . CONCLUSION In this prospect i ve international multicentre study , the 96 % detection rate indicates that the SNB procedure can be highly effective in patients 
    Output:
    
There is minimal comparative outcomes data on multicentric ( MC ) cancers compared to multifocal ( MF ) cancers comparing BCS or mastectomy .
There is also poor evidence of clinical outcomes following  therapeutic mammoplasty ( TM ) for MIBC compared to mastectomy .
There is limited evidence on the impacts of inter-tumoral heterogeneity relating to breast cancer subtypes in relation to individualised treatments and recommendations for types of breast surgery .