Comparative Planning Study of Different Tumor Bed Localization Modalities After Oncoplastic Conservative Surgery for Early-Stage Breast Cancer

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determine the impact of a post-lumpectomy mammogram (PLM) toward this goal, our institution analyzed the results of this imaging strategy in our breast cancer population. Materials/Methods: Beginning February 14, 2011, our institution made a practice change to obtain PLMs prior to adjuvant radiation on all patients with visible calcifications on preoperative mammography. Women who underwent breast-conserving surgery and were seen in consultation for treatment of intact breast cancer were eligible. Results: Over a three-year time period, 1,047 intact breast cancer patients were evaluated within the Radiation Oncology department, of whom 558 underwent a PLM and were deemed eligible for evaluation. Suspicious calcifications were noted in 60 patients (10.7% of patients). Residual calcifications were identified at the lumpectomy site in 38 cases. In 13 cases there were suspicious calcifications noted in a separate location from the original lumpectomy and in 9 cases calcifications were felt to be pulled near the lumpectomy site from a separate location. The PLM led to a change in management in 47 instances; the remainder had close or positive margins, for which surgery was recommended regardless. Within these 47 cases, 20 were found to have residual disease (42.5%), 26 had no residual disease and 1 remained undiagnosed. In total, 20/558 patients (3.6%) had residual disease and thus derived benefit from the PLM. Ductal carcinoma in situ (DCIS) was the primary histology in a majority of the patients with residual disease (60%). DCIS or extensive DCIS was identified in 85% (17/20) of these cases. Likewise, a high percentage of patients with margins 2 mm (75%) and grade 2/3 (70%) were identified within this population. Conclusion: Obtaining a PLM prior to radiation has the potential to be a useful tool in select patient populations. Prior studies have been limited by selection bias and small sample sizes. Our study overcomes these obstacles by evaluating a large patient population. Establishment of a nomogram to identify patients best suited to benefit from a PLM would further improve the utility of this technique. Author Disclosure: E.D. Donnelly: None. E. Neuschler: None. C. Henley: None. S.I. Gutiontov: None. J. Hayes: None. K. Bethke: None. N. Hansen: None. S.A. Khan: None. J.B. Strauss: None.