Limiting breast surgery to the proper minimum.

Clinical experience has resulted in the identification of a relatively small number of absolute contraindications to breast-conserving therapy (BCT). These contraindications are readily identified by a clinical evaluation and diagnostic mammography. Local failure rates of less than 10% at 10 years support the idea that patients can be reliably selected for BCT with standard clinical modalities. The availability of magnetic resonance (MR) imaging has raised questions about its role in patient selection for BCT. MR imaging identifies additional cancer in 10-54% of patients with apparently localized disease, resulting in mastectomies that would not otherwise have been done. Clinical experience suggests that the majority of this disease is controlled by radiotherapy. Studies demonstrating clinical benefit in terms of decreased rates of local recurrence or fewer surgeries are needed before MR is used for routine selection of patients for BCT.