Intra-operative radiological margins assessment in conservative treatment for non-palpable DCIS: correlation to pathological examination and re-excision rate

Abstract

What constitutes an adequate surgical margin in partial mastectomy is still controversial: intra-operative specimen radiogram is commonly used during partial mastectomy for nonpalpable lesions in order verify the adequacy of the resection but what margin is to be considered “adequate” is still debatable.An intraoperative specimen mammogram was performed during all consecutive conservative resections for nonpalpable DCIS and a 15-mm radiological margin was considered “adequate”. Margins were pathologically assessed and classified as “negative”, “close” or “positive” and the rate of margin involvement constitued the main outcome of the study.Among 272 conservative interventions, 80.51% had negative margins at final pathology, 3.31% had close margins and 16.18% had positive margins.An intraoperative “adequate” margin of 15 mm as defined on intraoperative specimen mammogram granted a high rate of histologically negative margin at primary surgery; this finding was paralleled by confirmation of the treatment as conservative in 95% of cases.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-2-243) contains supplementary material, which is available to authorized users.

Breast conserving surgery and intra-operative specimen radiography: Margin assessment by the surgeon or the radiologist?

“…The Kappa coeffi cient in our study of 0.25 showed a fair level of agreement between surgeon and radiologist. Previous studies showed that tumour grade, type and size did not infl uence margin assessment[30][31]. In this study, such conclusions could not be drawn due to the size of the patient cohort and the low positive margin rate.…”

Can Intraoperative Specimen Radiograph Predict Resection Margin Status for Radioguided Occult Lesion Localisation Lumpectomy for Ductal Carcinoma In Situ Presenting with Microcalcifications?

“…In this study, one of the objectives was to determine the optimal cutoff value of radiological margin to be used for predicting resection margin adequacy for DCIS, and ROC curves showed that a 15-mm radiological margin had the highest combination of sensitivity and specificity. Using a radiological margin of 15 mm was supported by Buggi et al, 26 Table 6. Studies reviewing accuracy of specimen radiography in predicting resection margin status in early breast cancers.…”

“…17,22 The reported sensitivity and specificity of specimen radiography in predicting resection margin status for early breast cancer ranges from 33% to 75% and 65% to 95%, respectively. 17,[19][20][21][22][23][24][25][26] Such heterogeneous data may be partially explained by the lack of international consensus regarding the optimal pathological and radiological margin to be used. Pathological margins of no ink on tumour, 1 mm, 2 mm, and 5 mm have all been used in previous studies, while the radiological margins used varied from 0 mm (lesion reaching specimen border) to 15 mm.…”

“…Only a few studies specifically investigated the accuracy of specimen radiography in predicting resection margin status in DCIS. 19,25,26 The radiological margins used in these studies ranged from 1 mm to 15 mm. In this study, one of the objectives was to determine the optimal cutoff value of radiological margin to be used for predicting resection margin adequacy for DCIS, and ROC curves showed that a 15-mm radiological margin had the highest combination of sensitivity and specificity.…”

“…Studies reviewing accuracy of specimen radiography in predicting resection margin status in early breast cancers. 17,[19][20][21][22][23][24][25][26] Abbreviations: DCIS = ductal carcinoma in situ; IDC = invasive ductal carcinoma; NA = not available; NPV = negative predictive value; PPV = positive predictive value; ROLL = radioguided occult lesion localisation. * Assessment by surgeon.…”