Impact of Cavity Shave Margins on Margin Status in Patients with Pure Ductal Carcinoma In Situ

Howard-McNatt, Marissa; Dupont, Elisabeth; Tsangaris, Theodore N.; Garcia-Cantu, Carlos; Chiba, Akiko; Berger, Adam C.; Levine, Edward A.; Gass, Jennifer; Ollila, David W.; Gallagher, Kristalyn; Lum, Sharon S.; Martínez, Ricardo; Willis, Alliric I.; Pandya, Sonali; Brown, Erin G.; Fenton, Andrew; Mendiola, Amanda; Murray, Mary K.; Haddad, Victor; Solomon, Naveenraj L.; Senthil, Maheswari; Bansil, Hannah; Snyder, Samuel K.; Edmonson, David; Lazar, Melissa; Namm, Jukes P.; Li, Fangyong; Butler, Meghan; McGowan, Noreen; Herrera, María Elisa; Avitan, Yoana; Yoder, Brian; McPartland, Tara; Chagpar, Anees B.

doi:10.1016/j.jamcollsurg.2020.11.019

Cited by 17 publications

(11 citation statements)

References 14 publications

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“…In the current study, 10 out of 42 patients (23.8%) had positive margins of the resected tumor. This figure conforms with previous studies, which reported variable rates of positive margins after BCS (23) . For instance, a multicenter prospective randomized-controlled trial was conducted on 396 breast cancer patients who underwent partial mastectomy with or without cavity shaving.…”

Section: Discussionsupporting

confidence: 93%

Routine Margin Shaving Of Lumpectomy Cavity During Breast Conserving Surgery Detects Occult Multifocal Cancer, A Prospective Study

Ali¹,

Gomaa²,

El‐Badry³

2021

The Egyptian Journal of Hospital Medicine

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Section: Discussionsupporting

confidence: 93%

Routine Margin Shaving Of Lumpectomy Cavity During Breast Conserving Surgery Detects Occult Multifocal Cancer, A Prospective Study

Ali¹,

Gomaa²,

El‐Badry³

2021

The Egyptian Journal of Hospital Medicine

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“…With respect to DCIS, which has a higher re-excision rate than invasive cancer, micro-calcifications are more easily visualized using VSI because the digital removal of overlying slices can improve image contrast. 25 We compared the sensitivity, specificity, and AUC of VSI in detecting pure DCIS and IBC cases and found them to be similar (data not shown). However, because the readers missed only a small number of postive margin cases, we could not draw any difinitive conclusions based on these results.…”

Section: Discussionmentioning

confidence: 97%

High-Resolution Full-3D Specimen Imaging for Lumpectomy Margin Assessment in Breast Cancer

Kulkarni

Schacht

et al. 2021

Ann Surg Oncol

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Background Two-dimensional (2D) specimen radiography (SR) and tomosynthesis (DBT) for breast cancer yield data that lack high-depth resolution. A volumetric specimen imager (VSI) was developed to provide full-3D and thin-slice cross-sectional visualization at a 360° view angle. The purpose of this prospective trial was to compare VSI, 2D SR, and DBT interpretation of lumpectomy margin status with the final pathologic margin status of breast lumpectomy specimens. Methods The study enrolled 200 cases from two institutions. After standard imaging and interpretation was performed, the main lumpectomy specimen was imaged with the VSI device. Image interpretation was performed by three radiologists after surgery based on VSI, 2D SR, and DBT. A receiver operating characteristic (ROC) curve was created for each method. The area under the curve (AUC) was computed to characterize the performance of the imaging method interpreted by each user. Results From 200 lesions, 1200 margins were interpreted. The AUC values of VSI for the three radiologists were respectively 0.91, 0.90, and 0.94, showing relative improvement over the AUCs of 2D SR by 54%, 13%, and 40% and DBT by 32% and 11%, respectively. The VSI has sensitivity ranging from 91 to 94%, specificity ranging from 81 to 85%, a positive predictive value ranging from 25 to 30%, and a negative predicative value of 99%. Conclusions The ROC curves of the VSI were higher than those of the other specimen imaging methods. Full-3D specimen imaging can improve the correlation between the main lumpectomy specimen margin status and surgical pathology. The findings from this study suggest that using the VSI device for intraoperative margin assessment could further reduce the re-excision rates for women with malignant disease.

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“…Notably, patients with ductal carcinoma in situ (DCIS) which is characterized by its discontinuous distribution and multifocality, more frequently fall victim to positive margin and reoperation when using other margin assessment methods (20). Fortunately, that is not the case with cavity shave method which has been proven to reduce positive margin rates by 65% among DCIS patients undergoing BCS (21). One systematic review encompassing 37 articles showed that compared with abandoning intraoperative margin assessment, FSA and IC could reduce reoperation rates from 35% to 10% and 11% respectively, which clearly testified for its clinical significance.…”

Section: Pathological Methodsmentioning

confidence: 99%

Development of intraoperative assessment of margins in breast conserving surgery: a narrative review

Li¹,

Li²

2022

Gland Surg

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Objective: We intend to provide an informative and up-to-date summary on the topic of intraoperative assessment of margins in breast conserving surgery (BCS). Conventional methods as well as cutting-edge technologies are analyzed for their advantages and limitations in the hope that clinicians can turn to this for reference. This review can also offer guidance for technicians in the future design of intraoperative margin assessment tools.Background: Achieving negative margins during BCS is one of the vital factors for preventing local recurrence. Conducting intraoperative margin assessment can ensure negative margins to a large extent and possibly relieve patients of the anguish of re-interventions. In recent years, innovative methods for margin assessment during BCS are advancing rapidly. And there is a lack of summary regarding the development of intraoperative margin assessment in BCS.Methods: A PubMed search with keywords "intraoperative margin assessment" and "breast conserving surgery" was conducted. Relevant publications were screened manually for its title, abstract and even full text to determine its true relevance. Publications on neo-adjuvant therapy and intraoperative radiotherapy were excluded. References from the searched articles and other supplementary articles were also looked into.Conclusions: Conventional methods for margin assessment yields stable outcome but its use is limited because of the demand on pathology staff and the trade-off between time and precision. Conventional imaging techniques pass the workload to radiologists at the cost of a significantly low duration of time.Involving artificial intelligence for image-based assessment is a further improvement. However, conventional imaging is inherently flawed in that occult lesions can't show on the image and the showing ones are ambiguous and open to interpretation. Unconventional techniques which base their judgment on cellular composition are more reassuring. Nonetheless, unconventional techniques should be subjected to clinical trials before putting into practice. And studies regarding comparison between conventional methods and unconventional methods are also needed to evaluate their relative efficacy.

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Impact of Cavity Shave Margins on Margin Status in Patients with Pure Ductal Carcinoma In Situ

Cited by 17 publications

References 14 publications

Routine Margin Shaving Of Lumpectomy Cavity During Breast Conserving Surgery Detects Occult Multifocal Cancer, A Prospective Study

Routine Margin Shaving Of Lumpectomy Cavity During Breast Conserving Surgery Detects Occult Multifocal Cancer, A Prospective Study

High-Resolution Full-3D Specimen Imaging for Lumpectomy Margin Assessment in Breast Cancer

Development of intraoperative assessment of margins in breast conserving surgery: a narrative review

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