Intraoperative Specimen Mammography Research Articles

Abstract PO2-28-11: How to improve margins in breast cancer surgery: a

Abstract Objective: Intraoperative specimen mammography (ISM) is a diffuse technique that allows surgeons to check specimens immediately after lumpectomy, instead of intraoperative frozen sections, definitely abandoned. in Italy and Europe, because it is regarded as too expensive and time-consuming examination. Although the specimen is slightly compressed, the radiological image can be distorted by tissue overlap, and this may affect the evaluation of tumor borders, resulting in extension of the lumpectomy. As ISM may be less precise due to inadequate compression, a vacuum effect was applied to the specimen to increase the precision of margin detection. Study design: This study was conducted at St. Anna Hospital Breast Unit, Turin, Italy. Women who underwent lumpectomy for cancer were eligible for inclusion. BCS resection was performed with a free margin, and the surgical specimen was imaged immediately by SSM and evaluated by an expert radiologist and surgeon.Inclusion criteria were: breast cancer detected by a screening test, and treatment with surgical lumpectomy. Both standard ISM (sISM) and vacuum ISM (vISM) were performed. A dedicated breast surgeon at the study institution performed both surgery and radiological scans, and their interpretation. A dedicated radiologist reviewed all of the images. ISM was performed by a digital specimen mammography system (Faxitron, Bioptics Inc., Tucson, AZ, USA) in the operating room. Specimen registration and ISM analysis took 3 min. sISM (two orthogonal projections) was performed. Specimens were sealed in plastic bags in the vacuum apparatus (TissueSAFE Milestone Medical, Sorisole, Italy); this process took a few seconds. 152 specimens obtained after lumpectomy from 1 April 2021 to 31 April 2022 were scanned. sISM (two orthogonal projections) was performed. Next, the specimen was placed in a vacuum bag, and vISM was performed. Additional tissue was removed if the surgeon considered that excision was inadequate. Finally, the specimen was sent for definitive histopathological analysis, which is the gold standard for the assessment of surgical margins. Intraoperative histological margin assessment was not performed. The sISM and vISM images and final histopathology reports were compared. A first experience on a limited number of patients to demonstrate feasibility of the technique, is reported in table 1 and 2. Results: For sISM, specificity was 43,85% [95 % confidence interval (CI) 35.96-51.73], sensitivity was 40.91% (95 % CI 33.09-48.73), positive predictive value (PPV) 10.98% (95 % CI 6.01-15.95) and negative predictive value (NPV) 81.43% (95 % CI 75.25-87.61). For vISM, specificity 92,31% (95 % CI 88,07-96.54), sensitivity 72.73% (95 % CI 65.65-79.81), PPV 61.54% (95 % CI 53.80-69.27) and NPV 95.24% (95 % CI 91.85-98.62). Conclusion: ISM is a valid, safe and quicker alternative to intraoperative histopathological study, but has been reported to be limited due to less compression than standard SSM. Consequently, ISM may result in a high percentage of false-positive results, meaning unnecessary wider resections that lead to increased operative times and worse aesthetic results. A vacuum effect was performed on the specimen to increase the precision of margin detection. vISM images seem to be easier to interpret than sISM images (Figs. 1–3) as they are characterized by a vacuum-created radiolucent rim that better defines the tumor margins. These data suggest that the vacuum technique is feasible, cost-saving and yields results that are similar to those from frozen sections but without the limitations, such as prolonged operating time, high variability in sensitivity due to pathologists abilities, risk of compromising the histology, and unreliability for small lumps and ductal carcinoma in situ. Keywords: Breast cancer; Intraoperative mammography; Lumpectomy; Specimen mammography; Vacuum intraoperative mammography. Table 1. Clinical Data IC, invasive cancer; DCIS ductal carcinoma in situ; ADH, atypical ductal hyperplasia; ILC, invasive lobular cancer; B3, lesions of uncertain malignant potential; IMPC, invasive micropapillary carcinoma; NST, no special type; sISM, standard intraoperative specimen mammography; vISM, vacuum intraoperative specimen mammography. ª Margin: 0, involved; 1, free Table 2. Figure 1 - 2 - 3 Standard intraoperative specimen mammography (left) and vacuum intraoperative specimen mammography (right). Citation Format: Maria Grazia Baù, Vincenzo Marra, Alessandra Surace, Donatella Tota, Maria Piera Mano, Aurelia Mondino, Alessandro Bottero, Elisabetta Robba. How to improve margins in breast cancer surgery: a [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-28-11.

Abstract PO1-23-07: The effect of intra-operative margin assessment during breast conserving surgery for breast cancer in a Dutch cohort

Abstract Background Pre-operative tumour localisation and intraoperative specimen radiography are necessary to perform adequate resection of non-palpable breast tumours. Intraoperative digital specimen mammography (IDSM), is an alternative to conventional specimen radiography (CSR) and has the benefit of providing immediate specimen evaluation and the potential of decreasing operation time. IDSM may also reduce positive margins and re-excision rates. IDSM was implemented in our hospital in 2018. The study objective was to evaluate the surgery time, radicality and re-excisions in IDSM and CSR. Methods A single centre retrospective cohort study with two cohorts: CSR (n=532) and IDSM (n=475). The primary outcome was duration of surgery. Secondary outcomes were margin status of the primary surgery, the perioperative cavity shave rate and the re-excision rate. Differences between cohorts were compared using univariate statistics and multiple regression to adjust for variables that were statistically significantly associated with duration of surgery. Results IDSM use was associated with 8 minutes shorter surgery time (B -8.242, p < 0.001). Treatment variables independently associated with the duration of surgery were use of IDSM, type of (axillary) surgery and the performance of cavity shaving. Cavity shaves were more often performed when IDSM was used (24% versus 14% in CSR group, p < 0.001), while the proportion of radical first surgeries (93% versus 96% respectively, p = 0.070) was comparable. Conclusion IDSM was associated with a modest reduction in duration of surgery. Surgeons performed more cavity shaves since IDSM but this was not reflected by a lower proportion of patients with positive margins. Table 1. Baseline characteristics of the CSR versus the IDSM cohort Table 2. Results of surgery in the CSR versus the IDSM cohort. Citation Format: Sophie Wooldrik, Elles van de Voort, Taco Klem, Thijs van Dalen, Cornelis Verhoef, Gerson Struik, Erwin Birnie. The effect of intra-operative margin assessment during breast conserving surgery for breast cancer in a Dutch cohort [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-23-07.

Comparison of Standard and Vacuum Specimen Mammography in the Detection of Margin Status in Conservative Surgery for Breast Cancer: a Cross-Sectional Diagnostic Study

Background: One of the most important factors that increases breast cancer (BC) recurrence after Breast-conserving surgery (BCS) is the positivity of the margins, which is found in permanent histological exams. Intra-operative specimen mammography (SM) can reduce the rate of margin positivity and re-operation. Our aim was to examine whether vacuum SM (VSM) is more accurate than standard SM (SSM) in detecting the positivity of the margins. Methods: For this cross-sectional study, in the operating room, excised specimens of 55 women with breast cancer who underwent lumpectomy were oriented by metallic staples and sutures for radiologic and histological assessment, respectively. In the radiology ward, SSM was first taken; then, the specimen was vacuum packed and VSM was performed. Afterwards, the specimen was sent for histopathological analysis as a gold standard for the assessment of surgical margins. Specimens’ margins were classified according to the size of clear margins in millimeters as zero or >0; and ≤1 or >1. Results: The mean age of all participants was 51.22 ± 10.58 years. Totally, 220 margins were assessed. According to classified margins (zero and 1 mm), for the detection of affected margins, the accuracy values of the VSM method were 90.52%, and 87.20% while these figures were 91.51% and 88.68% for SSM. There was substantial agreement between the two methods of detecting the affected margins (VSM and SSM), with Cohen's κ =0.66, 95% CI: 0.34-0.97, P-value <0.001). Finally, there was not a statistically significant difference in the proportion of detecting margin between SSM and VSM (McNemar test P-value =0.63). Conclusion: Specimen mammography with an adequate orientation of the tissue is an accurate and practical method for immediate intraoperative examination of the margin status in BCS, and VSM is not superior to SSM in the detection of affected margins.

Can We Do Breast-Conserving Surgery Without Intraoperative Frozen Section of Margin?

PurposeThis study was a retrospective and nonrandomized study to assess the safety and reliability of identifying the surgical margin in breast cancer breast-conserving surgery (BCS) by using intraoperative ultrasonic location and specimen mammography instead of traditional intraoperative frozen pathological section. MethodsAmong the patients who underwent BCS from May 2019 to October 2021, according to the different methods of evaluating the intraoperative margin, 104 breast cancer patients were included in the frozen edge group, 53 breast cancer patients were included in the freeze-free group, and the surgeon judged whether extended resection was needed based on the results of pathological section or evaluation of intraoperative ultrasound and mammography. The surgical margins of the two groups were judged by postoperative pathological results as the gold standard. ResultsThe median waiting pathology results time in the frozen edge group was 64 minutes, while the waiting time in the freeze-free group was 30 minutes, and the difference was statistically significant (P < .0001). The postoperative pathological results showed that the positive rate of the surgical margin in the frozen edge group was 0.96%. The coincidence rate of intraoperative frozen and postoperative pathological results was 99.04%. The coincidence rate between intraoperative mammography and postoperative pathological results was 100%. ConclusionsIn BCS, the method of using intraoperative staining markers combined with mammography to evaluate the resection margin is highly accurate, reliable, economical and convenient, and at the same time reduces the waiting time of the operator during the operation. However, this was not a randomized controlled study, and there was patient selection bias, and its safety needs to be confirmed by long-term follow-up. In the future, it is expected to become the mainstream means of evaluating.

Correlation of intra operative specimen imaging with final histopathology in breast conserving surgery for breast cancer.

To determine the effectiveness of specimen mammography in breast conserving surgery cases with respect to reduction in margin positivity rate, and to see whether the rate of secondary surgeries is decreased by intra-operative excision based on specimen mammography evaluation. The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from January 2018 to December 2019 related to all female breast cancer patients who underwent mastectomy or breast conserving surgery with the involvement of specimen mammography. Sensitivity, specificity, positive predictive value and negative predictive value of specimen mammography were calculated. Data was analysed using SPSS 20. Of the 226 patients initially assessed, 65(28.7%) were excluded, and the final sample comprised 161(71.2%) women with mean age 46.71±10.47 years. The sensitivity, specificity, positive predictive value and negative predictive value of specimen mammography for the sample were 65.8%, 80.8%, 54% and 87.3%, respectively. Performing specimen mammography for intra-operative margin assessment in 12 patients was likely to spare one patient from re-excision. Intra-operative specimen mammography was found to be a reliable tool for assessing margin status.

The Effect of Intraoperative Margin Assessment During Breast Conserving Surgery for Breast Cancer in a Dutch Cohort

IntroductionIntraoperative specimen radiography is a routinely used procedure to ensure adequate resection of non-palpable breast tumors. Intraoperative digital specimen mammography (IDSM) is an alternative to conventional specimen radiography (CSR) which provides immediate specimen evaluation and can potentially decrease operation time. IDSM may also result in lower positive margin and re-excision rates. IDSM was implemented in our hospital in 2018. The objective of this study was to evaluate the effect of using IDSM versus CSR on operation time, margin status and re-excision rates in breast conserving surgery. MethodsThe present study is a single-center retrospective cohort study with 2 patient cohorts: one which underwent CSR (n = 532) and one which underwent IDSM (n = 475). The primary outcome was the operation time. Secondary outcomes were the margin status of the primary surgery, the cavity shaving rate, and the re-excision rate. Differences between cohorts were compared using univariate statistics and multiple regression analyses to adjust for variables that were significantly different between the groups. ResultsIDSM use was associated with an 8-minute reduction in surgery time (B = -8.034, 95% CI [-11.6, -4.5]; P < .001). Treatment variables independently associated with the operation time included use of IDSM, type of surgery, and performance of cavity shaving. Cavity shaves were more often performed when IDSM was used (24% for IDSM vs. 14% for CSR, P < .001), while the proportion of negative margin rates (93% for IDSM vs. 96% for CSR, P = .070) was comparable. ConclusionIDSM was associated with a modest reduction in operation time. Surgeons performed more cavity shaves since the introduction of IDSM, but this increase was not reflected by difference in negative margin rates.

Analysis of Specimen Mammography with Artificial Intelligence to Predict Margin Status.

Intraoperative specimen mammography is a valuable tool in breast cancer surgery, providing immediate assessment of margins for a resected tumor. However, the accuracy of specimen mammography in detecting microscopic margin positivity is low. We sought to develop an artificial intelligence model to predict the pathologic margin status of resected breast tumors using specimen mammography. A dataset of specimen mammography images matched with pathologic margin status was collected from our institution from 2017 to 2020. The dataset was randomly split into training, validation, and test sets. Specimen mammography models pretrained on radiologic images were developed and compared with models pretrained on nonmedical images. Model performance was assessed using sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). The dataset included 821 images, and 53% had positive margins. For three out of four model architectures tested, models pretrained on radiologic images outperformed nonmedical models. The highest performing model, InceptionV3, showed sensitivity of 84%, specificity of 42%, and AUROC of 0.71. Model performance was better among patients with invasive cancers, less dense breasts, and non-white race. This study developed and internally validated artificial intelligence models that predict pathologic margins status for partial mastectomy from specimen mammograms. The models' accuracy compares favorably with published literature on surgeon and radiologist interpretation of specimen mammography. With further development, these models could more precisely guide the extent of resection, potentially improving cosmesis and reducing reoperations.

76 (PB-076) Poster - The effect of intra-operative margin assessment during breast conserving surgery for breast cancer in a Dutch cohort

Background: In the Netherlands, 60% of all breast cancers are screening detected and not palpable on physical examination. Pre-operative tumour localisation is therefore essential to perform an oncological complete resection while preserving healthy breast tissue and good cosmesis. Intraoperative digital specimen mammography (IDSM), in which a 2-view mammography of the specimen without compression is made in the operation room, is an alternative to conventional specimen radiography (CSR) that has the benefit of providing immediate specimen evaluation and potentially decreasing operation time.

Comparison of margin assessment between intraoperative digital and conventional specimen mammography in breast cancer: A preliminary study

BackgroundAlthough breast surgeons can request frozen section biopsies to evaluate margin status in breast-conserving surgery (BCS), specimen imaging is also a useful assessment tool. Intraoperative digital specimen mammography (IDSM) has recently been introduced in Korea. To estimate the clinical role of IDSM, this study compared the clinicopathologic factors of patients whose specimen was assessed with IDSM with those assessed using conventional specimen mammography (CSM). MethodsFrom October to December 2021, 78 breast cancer patients who underwent BCS were included in this study. The obtained specimens were assessed using IDSM (n = 44) and CSM (n = 34). Clinicopathologic factors included margin involvement status in specimen mammography and the results of frozen section biopsies. The radiation dose emitted from the specimen after mammography was measured using a portable device. ResultsThere were no significant differences in clinicopathological factors between the two groups, except the type of surgery for axillary lymph nodes. The closest distance from the margin to tumor was longer in the CSM group than in the IDSM group, although the difference was not statistically significant (p = 0.894). Margin involvement was accurately detected using IDSM due to the absence of compression (p < 0.001). In addition, the sensitivity and accuracy of IDSM were higher, and the false-negative rate was lower. ConclusionBoth specimen mammography methods were highly accurate in evaluating the margin involvement status. However, the margin status could be examined more precisely using IDSM because the specimen was not compressed to perform the examination. Because the IDSM system was installed in the operating room, it not only shortened performing routes but also reduced the operating time by providing immediate results.

Surgical Margins Status Assessment After Breast Conserving Surgery: Is There a Difference Between Surgeon and Radiologist Evaluation?

Background: The aim of this study is to evaluate the accuracy of intra-operative specimen mammography (ISM) in surgical margins status assessment and highlight the concordance between the interpretations of the surgeon and the radiologist. Methods: Our cross-sectional study included 130 patients with early breast cancer, surgically treated between October 2013 and September 2017 in the multidisciplinary breast center of the A.O.U. City of Health and Science (which is a complex of several hospitals) in Turin, Italy. All recruited patients underwent breast conservative surgery. Surgical margins were evaluated intraoperatively, using intra-operative specimen mammography. A standard compression intra-operative specimen mammography was obtained by the surgeon using the dedicated radiological equipment (Faxitron®, BioVision). After the surgeon’s evaluation of the margins, Faxitron images were sent to PACS. All ISMs images were analyzed by the same specialized radiologist in remote access to confirm the surgeon evaluation. We used kappa formula to report concordance. Results: The discordance rate of positive readings between the surgeon and the radiologist was 5.3% while that of negative readings was 6.9%. The concordance rate between radiologist and pathologist assessments was 100%. Intra-operative specimen mammography specificity was 94% (95% CI: 88–97), and sensitivity was 47% (95% CI: 38–56), with PPV found to be 53% (95% CI: 95% 44-62) and NPV determined to be 92% (95% CI: 86–96), when the assessment was made by the surgeon. Conclusion: Intra-operative specimen mammography is a helpful tool to identify infiltrated margins and to reduce the rate of secondary surgeries by recommending targeted re-excisions of corresponding orientations in order to obtain a final negative margin status. In our experience, not only radiologists but also surgeons could correctly read Faxitron® intra-operative specimen mammography.

116 Poster - Vacuum intraoperative specimen mammography: A novel technique

116 Poster - Vacuum intraoperative specimen mammography: A novel technique

Vacuum intraoperative specimen mammography: A novel technique

ObjectiveIntraoperative specimen mammography (ISM) is a diffuse technique that allows surgeons to check specimens immediately after lumpectomy. Although the specimen is slightly compressed, the radiological image can be distorted by tissue overlap, and this may affect the evaluation of tumour borders, resulting in extension of the lumpectomy. As ISM may be less precise due to inadequate compression, a vacuum effect was applied to the specimen to increase the precision of margin detection. Study designThis study was conducted at St. Anna Hospital Breast Unit, Turin, Italy. Women who underwent lumpectomy for cancer were eligible for inclusion. Both standard ISM (sISM) and vacuum ISM (vISM) were performed. Eighteen specimens obtained after lumpectomy from 1 April 2018 to 31 April 2018 were scanned. sISM (two orthogonal projections) was performed. Next, the specimen was placed in a vacuum, and vISM was performed. The examination was completed with a second orthogonal projection after removal of the vacuum, replacement of the specimen and repositioning of the vacuum. Additional tissue was removed if the surgeon considered that excision was inadequate. Finally, the specimen was sent for definitive histopathological analysis, which is the gold standard for the assessment of surgical margins. Intraoperative histological margin assessment was not performed. The sISM and vISM images and final histopathology reports were compared. ResultsFor sISM, specificity was 47 % [95 % confidence interval (CI) 25–70], sensitivity was 67 % (95 % CI 21–94), positive predictive value (PPV) was 20 % (95 % CI 6–51) and negative predictive value (NPV) was 88 % (95 % CI 53–98). For vISM, specificity was 100 % (95 % CI 80–100), sensitivity was 67 % (95 % CI 21–94), PPV was 100 % (95 % CI 34–100) and NPV was 94 % (95 % CI 72–99). ConclusionThese data suggest that the vacuum technique is feasible, cost-saving and yields results that are similar to those from frozen sections but without the limitations, such as prolonged operating time, high variability in sensitivity due to pathologists’ abilities, risk of compromising the histological report, and unreliability for small lumps and ductal carcinoma in situ.

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

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

P310 - Vacuum intraoperative specimen mammography: a new technique

P310 - Vacuum intraoperative specimen mammography: a new technique

P343 - The application of intraoperative specimen mammography in breast conserving surgery

P343 - The application of intraoperative specimen mammography in breast conserving surgery

Intraoperative Specimen Mammography for Margin Assessment in Breast-Conserving Surgery.

The purpose of this study aimed to determine whether intraoperative specimen mammography is an effective margin assessment method in Asian women. Thus, 182 patients who underwent breast-conserving surgery (BCS) were evaluated. After wide excision, intraoperative specimen mammography was used to assess margin adequacy. The control group comprised 84 patients who underwent BCS and were evaluated for margin of frozen section during surgery. 61.6% patients had dense breasts and 85.7% of dense breasts could margin assess by intraoperative specimen mammography. There were no significant differences in the incidence of extremely close margins (p = 0.421) and second operation (p = 0.252) between both groups. Significant correlations were found between radiological and histological margins (R2 = 0.222, p < 0.05). The frozen section analysis group had longer operative time than the specimen mammography group. The study results show that intraoperative specimen mammography of breast lesions in BCS is useful in identifying margin clearance.

Obtaining adequate surgical margin status in breast-conservation therapy: intraoperative ultrasound-guided resection versus specimen mammography.

Background and aimThe purpose of breast-conserving surgery (BCS) for women with cancer is to perform an oncological radical procedure with disease-free margins at the final histological assessment and with the best aesthetic result possible. Intraoperative resected specimen ultrasound and intraoperative resected specimen mammography may reduce the rates of positive margins and reexcision among patients undergoing conserving therapy. Our objective is to compare the two methods with the histopathological results for a preset cut off and asses which parameters can influence the positive margin status.MethodA prospective study was performed on 83 patients who underwent breast conservation surgery for early breast cancer (pT1-3a pN0-1 M0) between 2014 and 2016. After excision the specimen was oriented in the operating room by the surgeon. Metallic clips and threads were placed on margins: one clip and the long thread at 12 o’clock, two clips and the short threads at 9 o’clock. The next step was intraoperative ultrasound assessment of the specimen. For the margins under 2 mm we performed selective margin shaving, followed by mammography to identify and document the lesion and finally histopathological examination of the specimen with reporting the gross and microscopic margins. The positive margins required re-excision or boost of radiation at the posterior or anterior margins, depending on the case.ResultsWe set a cut-off at 2 mm. The sensitivity and specificity of the intraoperative margin assessment via the ultrasound method were 90.91% (95% CI 70.84–98.88%) and 67.21% (95% CI 54–78.69%) respectively. The sensitivity and specificity of the intraoperative margin assessment via the mammographic procedure were 45.45% (95% CI 24.39–67.79%) and 85.25% (95% CI 73.83–93.02%) respectively. There was positive correlation between the histopathological and intraoperative ultrasound exam (p=0.018) and negative correlation between the histopathological exam and the post-operative mammographic exam (p=0.68). We found a positive correlation between the positive margin status and age (<40), preoperative chemotherapy, intraductal carcinoma, inflammatory process around the tumor, and the immunohistochemical triple negative profile.ConclusionsAccording to our results, the intraoperative ultrasound of the breast specimen for a cutt-off at 2 mm can decrease the rates of margin positivity compared to the mammographic procedure and has the potential to diminish the number of subsequent undesired re-excisions.

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

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.

Comparison of intra-operative specimen mammography to standard specimen mammography for excision of non-palpable breast lesions: a randomized trial.

Standard specimen mammography (SSM) is performed in the radiology department after wire-localized excision of non-palpable breast lesions to confirm the presence of the target and evaluate margins. Alternatively, intra-operative specimen mammography (ISM) allows surgeons to view images in the operating room (OR). We conducted a randomized study comparing ISM and SSM. Women undergoing wire-localized excision for breast malignancy or imaging abnormality were randomized to SSM or ISM. For SSM, the specimen was transported to the radiology department for imaging and interpretation. For ISM, the specimen was imaged in the OR for interpretation by the surgeon and sent for SSM. Interpretation time was from specimen leaving OR until radiologist interpretation for SSM and from placement in ISM device until surgeon interpretation for ISM. Procedure and interpretation times were compared. Concordance between ISM and SSM for target and margins was evaluated. 72 patients were randomized, 36 ISM and 36 SSM. Median procedure times were similar, 48.5 (17-138) min for ISM, and 54 (17-40) min for SSM (p=0.72), likely since specimens in both groups traveled to radiology for SSM. Median interpretation time was significantly shorter with ISM, 1 (0.5-2.0) and 9 (4-16) min for ISM and SSM, respectively (p<0.0001). Among specimens with ISM and SSM, concordance was 100% (35/35) for target and 93% (14/15) for margins. In this randomized trial, use of ISM compared with SSM significantly reduced interpretation times, while accurately identifying the target. This could result in decreased operative costs from shorter OR times with use of ISM.

Intraoperative 2D specimen mammography (IO-2DSM) and its utility in breast conserving surgery (BCS) for breast cancer

Shah, Parth K. MB, BS; Loseth, Caitlin R.; Silva, Edibaldo MD, PhD, FACS Author Information