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Effect of three-dimensional intraoperative imaging on surgical outcomes with breast conservation therapy

Published:December 28, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.12.021

      Highlights

      • This is one of the only studies to evaluate the effect of intraoperative three-dimensional (3-D) tomosynthesis on breast conservation therapy (BCT).
      • The focus of this study was the impact of 3-D tomosynthesis on positive margin rates with BCT.
      • The main analysis found no significant difference in the margin positivity rates between 3-D tomosynthesis and standard imaging.
      • The secondary measures also found no benefit with the use of intraoperative 3-D tomosynthesis.

      Abstract

      Background

      Breast conservation therapy (BCT) is frequently performed for breast cancer and associated with a significant risk for positive margins. Intraoperative three-dimensional (3-D) tomosynthesis potentially could limit the risk of positive margins.

      Methods

      Retrospective review of an institutional breast cancer registry. Evaluated BCT cases for a two year time period prior to and after the introduction of intraoperative 3-D tomosynthesis. Primary outcome was the effect of 3-D tomosynthesis on margin positivity rates. Secondary measures were the impact of 3-D tomosynthesis on additional margin procurements at the index surgery and operative time.

      Results

      A total of 228 cases were evaluated with 106 cases utilizing 3-D tomosynthesis and 122 cases with standard imaging. No significant difference in margin positivity rates between the cohorts at 23.9% versus 15.8% for 3-D tomosynthesis and standard imaging respectively (OR 1.53, CI 0.772–3.032, P = 0.221). 3-D tomosynthesis was associated with increased margin procurement rates (OR 2.34, 95%CI 1.303–4.190, P = 0.004) and longer operative times (P < 0.001).

      Conclusion

      Intraoperative 3-D tomosynthesis was not found to limit margin positivity rates or improve the performance of the procedure.
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