Does Additional Margin Excision During Pegulicianine Fluorescence-Guided Surgery (pFGS) Affect Patient Breast Satisfaction?

Why clinicians should know about it

• Picked for Breast and Endocrine Surgery (paper of the day, 21 October 2026): Randomized trials of fluorescence‑guided margin excision in lumpectomy

Abstract

BACKGROUND: Use of pegulicianine fluorescence-guided surgery (pFGS) for intraoperative residual tumor assessment in breast cancer lumpectomy surgery removed additional tumor and reduced second surgeries. This study assessed breast satisfaction among patients with and without additional margin excision and preference for optimizing cosmesis versus avoiding a second surgery. METHODS: Two clinical trials randomized stages 0 to 3 breast cancer patients to pFGS or standard lumpectomy. For pFGS, additional cavity margin specimens were taken at sites of pegulicianine fluorescence after standard lumpectomy. Surveys of BREAST-Q satisfaction were administered in trials 1 and 2, and surveys of cancer worry and patient preference information (PPI) were administered in trial 2. RESULTS: Satisfaction surveys were completed 6 to 12 months postoperatively by 14 % of the trial 1 and 67 % of the trial 2 patients. The mean postoperative breast satisfaction score was 75.8 (n = 99; range, 15-100) for the pegulicianine-assisted arm patients versus 79.0 (n = 19; range, 35-100) for the control subjects (p = 0.53). The mean breast satisfaction score was 73.6 (n = 52; range, 33-100) among the patients with additional pFGS-assisted cavity margins taken versus 78.5 (n = 66; range, 15-100) (p = 0.17) among those with no additional tissue taken. Overall, 70.6 % of the respondents strongly preferred or preferred avoiding a second surgery, 19.6 % had no preference, and only 9.8 % preferred to optimize cosmetic outcomes. No patient strongly preferred to optimize cosmetic outcomes CONCLUSIONS: No decrease in breast satisfaction was observed among the breast cancer lumpectomy patients undergoing pFGS intraoperative margin assessment despite additional tissue removal. Most of the patients valued avoiding a second surgery over maximizing cosmetic outcome.

Abstract as published, via PubMed.