Impact of intraoperative specimen mammography on margins in breast-conserving surgery

Abstract

Abstract.A positive resection margin is one of the most significant risk factors for local breast cancer recurrence following breast-conserving surgery (BCS). Intraoperative specimen mammography (SMMG) is routinely used to evaluate the surgical margin at our institution. The aim of the present study was to assess the adequacy of SMMG for margin assessment. The patient cohort included 174 women who underwent BCS in 2006. The sensitivity and specificity of SMMG were assessed by comparing the margins assessed by histological and radiological methods. It was also examined whether the rate of positive histological margins was decreased by re-excision following SMMG evaluation. A total of 23 false-negatives and 6 false-positives were determined by SMMG. The sensitivity and specificity of SMMG margin assessment for patients with primary breast cancer were 20.6 and 94.6%, respectively. The positive predictive value was 50% and the negative predictive value was 82.2%. A subgroup analysis revealed that the sensitivity and specificity of SMMG in cases with ductal carcinoma in situ (DCIS) were higher compared with those in invasive ductal carcinoma. Furthermore, the positive histological margin rate was not affected by re-excision. Although the general usefulness of intraoperative SMMG was not proven, this procedure may be useful in specific cases, particularly those with DCIS and those diagnosed by stereotactic biopsy. A prospective study with exact criteria and a standard procedure is required. IntroductionThe standard surgical treatments for breast cancer are breast-conserving surgery (BCS) and mastectomy. The essential purpose of BCS is to completely remove the cancer while maintaining the cosmetic appearance of the breast, which is important to the patients. Previous studies have reported that BCS followed by radiation had a similar outcome to that of mastectomy in terms of mortality rate (1-5). However, a positive margin and young age (<53-55) are significant risk factors for ipsilateral breast tumor recurrence (IBTR) (6-8). Moreover, a meta-analysis by the Early Breast Cancer Trialists' Collaborative Group showed that local recurrence affected survival rate (9). Recently, Moran et al (10) reported that the American Society of Radiation Oncology consensus guideline uses the results of a meta-analysis of margin width and IBTR. This guideline also indicated the optimal criteria for determining margin width in BCS. However, despite numerous previous studies, the criteria for intraoperative margin assessment in BCS have yet to be established. At our institution, intraoperative specimen digital mammography (SMMG) is used to assess the resection margins in all cases of BCS. The aim of the present study was to evaluate the usefulness of SMMG for achieving margin-free resection of breast tumors. Patients and methods Patients.A retrospective study of the medical records, pathological diagnosis and re-evaluation by SMMG of 426 breast cancer patients who underwent BCS at the Aichi Cancer Center Hospital (Nagoya, Japan) between J...

Obtaining Adequate Surgical Margin Status in Breast-Conservation Therapy: Intraoperative Ultrasound-Guided Resection Versus Specimen Mammography

“…Various studies are available in the literature to evaluate the mammography of the excised specimen, whose values are close to those obtained in the present study. Among them we mention the study of Bathla L et al in which the sensitivity of the method was 20.6% and the specificity 94.6%, the study by Hisada T et al in which the sensitivity of the method was 58.5% and the specificity of 91.8%, the study by McCormick TJ et al in which sensitivity was 54.55%, and the specificity was 87.80%[ 25 , 26 , 27 ]…”

“…Another approach designed to achieve negative margins is mammography of the specimen. The accuracy of the method is determined by its ability to provide information on the presence or absence of microcalcifications, but also on parenchymal distortions [ 25 , 26 , 27 ]. Among the limitations of this technique are the “pancake” phenomenon and the existence of an invasive lobular carcinoma surrounded by dense tissue.…”

Radiographically guided shave margins may reduce lumpectomy re-excision rates

“…Using radiographic guidance alone allows for real‐time evaluation of margins by the surgeon without significant increase in operative time or pathology resources. When considering the use of intraoperative imaging without associated frozen assessment, the exact decrease in margin positivity rate is still being evaluated …”

“…When considering the use of intraoperative imaging without associated frozen assessment, the exact decrease in margin positivity rate is still being evaluated. 1,2,8,9 The purpose of this study was to compare the rates of margin re-excision before and after intraoperative radiographic equipment was used to guide shave margin excision.…”

The application of intraoperative specimen mammography for margin status assessment in breast‐conserving surgery: A single‐center retrospective study

“…Second, compared to it specificity, the sensitivity of SR was relatively poor, as was found in some other studies. [8][9][10] In conclusion, SR is able to identify most negative margins, but its diagnostic sensitivity still needs to be improved.…”