Surgery for early and minimally invasive breast cancer.

An increasing number of early and minimally invasive breast cancers are being detected by mammography screening. The role of image-guided core biopsy in nonpalpable breast lesion evaluation is being defined, with issues of cost-effectiveness, diagnostic accuracy, and ability to direct definitive management remaining to be elucidated. The long-term efficacy of breast conservation therapy for early breast cancer continues to be confirmed. Review of special issues in breast conservation therapy demonstrates no benefit to eliminating adjunctive radiation therapy or to limiting therapy in the elderly patient with breast cancer. The distribution of cancer in the duct-lobular system indicates the potential for radical segmental extension. It also influences local recurrence following breast-conserving surgery. Sentinel lymph node dissection may supplant standard axillary dissection as a major prognostic determinant of metastatic disease. These areas of scientific investigation continue to define the role of surgery in early and minimally invasive breast cancer.