Efficacy of intraoperative specimen radiography as margin assessment tool in breast conserving surgery

Purpose This is the first study to systematically evaluate the diagnostic accuracy of intraoperative specimen radiography on margin level and its potential to reduce second surgeries in patients treated with neoadjuvant chemotherapy. Methods This retrospective study included 174 cases receiving breast conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) of primary breast cancer. Conventional specimen radiography (CSR) was performed to assess potential margin infiltration and recommend an intraoperative re-excision of any radiologically positive margin. The histological workup of the specimen served as gold standard for the evaluation of the accuracy of CSR and the potential reduction of second surgeries by CSR-guided re-excisions. Results 1044 margins were assessed. Of 47 (4.5%) histopathological positive margins, CSR identified 9 correctly (true positive). 38 infiltrated margins were missed (false negative). This resulted in a sensitivity of 19.2%, a specificity of 89.2%, a positive predictive value (PPV) of 7.7%, and a negative predictive value (NPV) of 95.9%. The rate of secondary procedures was reduced from 23 to 16 with a number needed to treat (NNT) of CSR-guided intraoperative re-excisions of 25. In the subgroup of patients with cCR, the prevalence of positive margins was 10/510 (2.0%), PPV was 1.9%, and the NNT was 85. Conclusion Positive margins after NACT are rare and CSR has only a low sensitivity to detect them. Thus, the rate of secondary surgeries cannot be significantly reduced by recommending targeted re-excisions, especially in cases with cCR. In summary, CSR after NACT is inadequate for intraoperative margin assessment but remains useful to document removal of the biopsy site clip.

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“… CI confidence interval, NACT neoadjuvant chemotherapy a data from a previously published analysis[ 11 ] …”

Section: Resultsmentioning

confidence: 99%

Does conventional specimen radiography after neoadjuvant chemotherapy of breast cancer help to reduce the rate of second surgeries?

Schaefgen

Funk

Sinn

et al. 2021

Breast Cancer Res Treat

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“…Ideally, this leads to tumor free resection margins and can help to avoid a secondary re-excision. One recent study performed at our breast unit assessed the e cacy of CSR on both margin and case level for the recommendation of targeted resections in a cohort of patients with primary surgical treatment [11]. In this study with patients who did not receive NACT, a reduction of in ltrated margins from 11-4%, translating to a reduction of secondary procedures from 34.5-21.7% on case level, was reported [12] [13].…”

Section: Introductionmentioning

confidence: 93%

“…a data from a previously published analysis[11]. CI: con dence interval, NACT: neoadjuvant chemotherapy…”

mentioning

confidence: 99%

Does Conventional Specimen Radiography After Neoadjuvant Chemotherapy of Breast Cancer Help To Reduce The Rate of Second Surgeries?

Schaefgen

Funk

Sinn

et al. 2021

Preprint

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PurposeThis is the first study to systematically evaluate the diagnostic accuracy of intraoperative specimen radiography on margin level and its potential to reduce second surgeries in patients treated with neoadjuvant chemotherapy. MethodsThis retrospective study included 174 cases receiving breast conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) of primary breast cancer. Conventional specimen radiography (CSR) was performed to assess potential margin infiltration of the target lesion and recommend an intraoperative re-excision of any radiologically positive margin. The histological workup of the specimen served as gold standard for the evaluation of the accuracy of CSR and the potential reduction of second surgeries by CSR-guided re-excisions. A subgroup analysis was performed for patients with and without clinical complete response. Results 1044 margins were assessed. Of 47 (4.5%) histopathological positive margins, CSR identified 9 correctly (true positive). 38 infiltrated margins were missed (false negative). This resulted in a sensitivity of 19.2%, a specificity of 89.2%, a PPV of 7.7% and a NPV of 95.9%. The rate of secondary procedures was reduced from 23 to 16 with a number needed to treat (NNT) of CSR guided intraoperative re-excisions of 25. In the subgroup of patients with cCR, the prevalence of positive margins was 10/510 (2.0%), PPV was 1.9% and the NNT was 85. ConclusionPositive margins after NACT are rare and CSR has only a low sensitivity to detect them. Thus, the rate of secondary surgeries cannot be significantly reduced by recommending targeted re-excisions, especially in cases with cCR.

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“…The limitation of the conventional x-ray technique is the long turnaround time for the x-ray result. [4][5] Also, the specimen must be examined on the mammogram machine outside the operating room. The image acquired from the conventional x-ray technique is a 2D image which may lead to misinterpretation, as a calcified lesion may be located in different positions depending on specimen rotation during the x-ray.…”

Section: Introductionmentioning

confidence: 99%

Development of a Micro Computed Tomography Scanner for Localization of Lesions and Assessment of the Margin Width of Resected Breast Specimens in the Operating Room

et al. 2022

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Objective: The objective of this study was to develop a micro-computed tomography (micro-CT) scanner machine and software dedicated to the localization of calcification in resected breast tissue specimens in a 3-dimensional image. The micro-CT scanner was designed to be used as a mobile machine, particularly for use in the operating room.Material and Methods: The system was designed to perform a 360-degree scan on a rotating table between the x-ray source and the detector sensor using a cone beam x-ray. The prototype was developed collaboratively between Prince of Songkla University (PSU) and the National Science and Technology Development Agency, Thailand (NSTDA). This was the first prototype for scanning specimens. The overall scan time and the image reconstruction was 5-10 minutes. The machine was tested for safety by PTEC (Electrical and Electronic Product Testing Center of NSTDA).Results: The specification of MiniiScan® and preliminary results of 3D image reconstruction of the resected breast tissue specimen by using the MiniiScan® are present in this report. The study evaluated specimens form 31 patients obtained from June 2016 through January 2018. The average scan time was 10.4 minutes. The turnaround time of the conventional technique was 27.9 minutes. The quality of the 3D images as evaluated by PSU staffs was superior to the conventional x-ray images done with the standard mammogram. The 3D images can display the correct position of calcification and a width between calcification to margins in all directional plane.Conclusion: The 3D images of the prototype intraoperative MiniiScan® scan were superior in quality to the standard mammogram, and had a quicker turnaround time for intraoperative application. Surgeons can use this machine in the operating room instead of relying on the conventional x-rays with a mammogram machine outside the operating theater.

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Efficacy of intraoperative specimen radiography as margin assessment tool in breast conserving surgery

Cited by 23 publications

References 43 publications

Does conventional specimen radiography after neoadjuvant chemotherapy of breast cancer help to reduce the rate of second surgeries?

Does conventional specimen radiography after neoadjuvant chemotherapy of breast cancer help to reduce the rate of second surgeries?

Does Conventional Specimen Radiography After Neoadjuvant Chemotherapy of Breast Cancer Help To Reduce The Rate of Second Surgeries?

Development of a Micro Computed Tomography Scanner for Localization of Lesions and Assessment of the Margin Width of Resected Breast Specimens in the Operating Room

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