Breast conserving surgery has been increasing over the last few decades. Techniques are emerging that aim to improve cosmesis by making the excision smaller, more precise or by avoiding excision at all.
Wire localization has been the mainstay of tumour localisation for several decades but has problems - so new technologies are emerging that involve placing a seed to be located by a detector.
3D navigation aims to show the tumour location in real-time in relation to the dissection device and in the future this could be combined with augmented reality displays.
Whilst localisation devices aim to optimise surgical excision, perhaps excision is not actually required - lesion ablation techniques are being developed that induce targeted coagulative necrosis of tissue. Techniques cause tissue destruction by heating, freezing or denaturing tissues.
Alternatively, minimally invasive excision includes vacuum assisted biopsies and other devices such as the Medtronic intact system that has an integrated diathermy based retrieval system for capture of lesions up to 2cm in size. Studies are starting to look at minimally invasive excision of breast cancers such as the SMALL study.
There are a plethora of techniques emerging aiming to provide intraoperative margin assessment. These work either by providing enhanced specimen imaging – e.g. micro-CT Or by providing information about the tissue by measuring electrical conductivity, optical absorption or chemical characteristics of the cells in an attempt to determine tissue type and decrease positive margin rates.
Camera and computer technology are evolving allowing more accurate 3D breast Assessment. In the future these techniques may be used to help determine the best operative approach as well as giving the patient and surgeon realistic expectations to aid shared decision making.
Ductoscopy and Microrobotics
Miniaturization of technology allows for increasing duct exploration and early disease identification.