Table 1. CALLER Toolbox update on references and strength of recommendation.

CALLER Toolbox tool	2015 strength of recommendation	2018 strength of recommendation	Resource intensiveness*	Updated references
Preoperative diagnostic imaging should include full-field digital mammography and supplementary imaging to include ultrasound as needed	Strong-moderate	Similar	Moderate	(13-21)
Minimally invasive breast biopsy (MIBB) for breast cancer diagnosis	Strong	Similar	Low	–
Multidisciplinary discussions to include radiology, pathology, surgery, and radiation and medical oncology	Strong-moderate	Similar	Low	(12,22-31)
For nonpalpable breast lesions, the use of radioactive seeds, intraoperative US, or wire localization to direct lesion excision is recommended	Strong	Similar	Moderate	(32-42)
Oncoplastic techniques can reduce the need for reoperation in anatomically suitable patients	Strong-moderate	Strong	Moderate	(3,43-60)
Specimen orientation of 3 or more margins	Strong	Similar	Low	(61-68)
Specimen radiograph with surgeon intraoperative review	Strong	Similar	Low	(13,14,69-74)
Consider cavity shave margins in patients with T2 or greater tumor size or TI with extensive intraductal carcinoma (EIC)	Strong-moderate	Strong	Low	(75-77)
Intraoperative pathology assessment of lumpectomy margins may help decrease re-excision when feasible	Strong-moderate	Strong	Highest	(69,78-90)
Compliance with the SSO-ASTRO margin guideline to not routinely re-operate for close margins with no tumor on ink in patients with invasive cancer	Strong-moderate	Strong	Low	(4,5,8,11,91-106)

*, resource intensiveness to adopt if system not already in place.