Highlights
- •Two dimensional specimen radiography reduces positive margin rates by 7.8%.
- •Adding orthogonal (3D) images reduces positive margin rates by another 1.1%.
Abstract
Background
Standard two-dimensional (2D) specimen radiography may guide intraoperative re-excision
of margins in patients undergoing breast conserving surgery. We sought to determine
the impact of three-dimensional (3D) specimen imaging in further reducing positive
margin rates.
Methods
A prospective study of 100 patients in which both 2D and 3D specimen radiographies
were performed. The impact of orthogonal view on intraoperative surgical management
and final margins was assessed.
Results
Ten patients had no residual tumor; therefore, 90 patients formed the cohort of interest.
Of them, 21 patients (23.3%) had ductal carcinoma in situ; 18 (20.0%) had invasive
cancer; and 51 (56.7%) had both. Median tumor size was 1.7 cm (range, .2 to 8.1 cm).
On the basis of 2D imaging, surgeons stated they would take more tissue in 26 patients
(28.9%). Three-dimensional imaging changed management in 4 patients (6.3%). One of
these patients would have had positive margins if the intraoperative resection done
on the basis of the 3D imaging would have been omitted.
Conclusions
Three-dimensional specimen imaging results in further intraoperative re-excision in
6.3% of patients and may reduce re-excision rates in 2.2%.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Society of Surgical Oncology–American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer.Ann Surg Oncol. 2014; 21: 704-716
- A prospective study of tumor and technical factors associated with positive margins in breast-conservation therapy for nonpalpable malignancy.Am J Surg. 2012; 204: 263-268
- Predictors of margin status after breast-conserving operations in an underscreened population.Langenbeck's Arch Surg/Deutsche Gesellschaft Chirurgie. 2013; 398: 455-462
- Positive margin rates following breast-conserving surgery for stage I-III breast cancer: palpable versus nonpalpable tumors.J Surg Res. 2012; 177: 109-115
- High resolution intra-operative two-dimensional specimen mammography and its impact on second operation for re-excision of positive margins at final pathology after breast conservation surgery.Am J Surg. 2011; 202: 387-394
- Radiography of the surgical specimen in early stage breast lesions: diagnostic reliability in the analysis of the resection margins.La Radiologia Med. 2007; 112: 366-376
- The effect of introducing an in-theatre intra-operative specimen radiography (IOSR) system on the management of palpable breast cancer within a single unit.Breast. 2012; 21: 459-463
- Evaluation of lumpectomy surgical specimen radiographs in subclinical, in situ and invasive breast cancer, and factors predicting positive margins.Diagn Interv Imaging. 2012; 93: 871-877
- Breast surgical specimen radiographs: how reliable are they?.Eur J Radiol. 2011; 79: 245-249
- Preoperative localization and surgical margins in conservative breast surgery.Int J Surg Oncol. 2013; 2013: 793819
- Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center.Am J Clin Pathol. 2012; 138: 657-669
- Cost-effectiveness analysis of routine frozen-section analysis of breast margins compared with reoperation for positive margins.Ann Surg Oncol. 2011; 18: 3204-3209
- Separate cavity margin sampling at the time of initial breast lumpectomy significantly reduces the need for reexcisions.Am J Surg Pathol. 2005; 29: 1625-1632
- Effect of cavity shaving on reoperation rate following breast-conserving surgery.Breast J. 2008; 14: 570-573
- Influence of surgical technique on mastectomy and reexcision rates in breast-conserving therapy for cancer.Int J Surg Oncol. 2012; 2012: 725121
- A randomized prospective study of lumpectomy margin assessment with use of MarginProbe in patients with nonpalpable breast malignancies.Ann Surg Oncol. 2014; 21: 1589-1595
Article info
Publication history
Published online: July 18, 2015
Received in revised form:
April 30,
2015
Received:
February 22,
2015
Footnotes
This study was supported in part by Faxitron Biosys.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
