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Gland Surg. 2018 Dec;7(6):536-553. doi: 10.21037/gs.2018.11.03.

Update of the American Society of Breast Surgeons Toolbox to address the lumpectomy reoperation epidemic.

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Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, USA.
Gundersen Health System, Norma J. Vinger Center for Breast Cancer, La Crosse, WI, USA.


In 2015, the American Society of Breast Surgeons (ASBrS) convened a multidisciplinary consensus conference, the Collaborative Attempt to Lower Lumpectomy Reoperation Rates (CALLER). The CALLER conference endorsed a "toolbox" of multiple processes of care for which there was evidence that they were associated with fewer reoperations. We present an update of the toolbox taking into consideration the latest advances in decreasing re excision rates. In this review, we performed a comprehensive review of the literature from 2015-2018 using search terms for each tool. The original ten tools were updated with the latest evidence from the literature and our strength of recommendation. We added an additional section looking at new tools and techniques that may provide more accurate intraoperative assessment of margins. The updates on the CALLER Toolbox for lumpectomy will help guide surgeons to various resources to aid in the removal of breast cancer, while being aware of cosmesis and decreasing re excision rates.


Breast conservation; re-excision rate; re-operation rate; toolbox

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Conflicts of Interest: The authors have no conflicts of interest to declare.

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