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Efficacy of intraoperative specimen radiography as margin assessment tool in breast conserving surgery

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Abstract

Purpose

To explore the ability of intraoperative specimen radiography (SR) to correctly identify positive margins in patients receiving breast conserving surgery (BCS). To assess whether the reoperation rate can be reduced by using this method.

Methods

This retrospective study included 470 consecutive cases receiving BCS due to a primarily diagnosed breast cancer. SR was carried out in two planes, assessing the specimen regarding the presence of the lesion and its relation to all margins. If indicated, re-excision of selective orientations was advised. Under consideration of gross inspection and the SR-findings, it was up to the surgeon whether to perform re-resections. The recommendations for re-excision were, separately for each orientation, compared to the histopathological results, serving as gold standard.

Results

Intraoperative SR was performed in 470 cases, thus 2820 margins were assessed. Of those, 2510 (89.0%) were negative and 310 (11.0%) positive. SR identified 2179 (77.3%) margins correctly as negative, whereas 331 (11.7%) clear margins were misjudged as positive. Of 310 infiltrated margins, SR identified 114 (4.0%) correctly, whereas 196 (7.0%) infiltrated margins were missed. This resulted in a sensitivity/specificity of 36.8%/86.8% and PPV/NPV of 25.6%/91.8%. Through targeted re-resections positive margins could be reduced by 31.0% [310 to 214 (7.6%)]. On case level, the rate of secondary procedures could be reduced by 37.0% [from 162 to 102 (21.7%)].

Conclusions

SR is a helpful tool to identify infiltrated margins and to reduce the rate of secondary surgeries by recommending targeted re-excisions of according orientations in order to obtain a final negative margin status.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany

    Annika Funk, Jörg Heil, Aba Harcos, Christina Gomez, Hans Junkermann, André Hennigs, Fabian Riedel, Benedikt Schäfgen, Sarah Hug, Anna Maier, Maria Blumenstein, Christoph Domschke, Sarah Schott, Markus Wallwiener, Joachim Rom, Florian Schütz, Christof Sohn & Michael Golatta

  2. Department of Radiology, Heidelberg University, Heidelberg, Germany

    Anne Stieber

  3. Department of Pathology, Heidelberg University, Heidelberg, Germany

    H.-P. Sinn

  4. Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-University Berlin and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Berlin, Germany

    Geraldine Rauch

  5. Berlin Institute of Health, Berlin, Germany

    Geraldine Rauch

Authors
  1. Annika Funk
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  2. Jörg Heil
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  4. Christina Gomez
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  5. Anne Stieber
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  6. Hans Junkermann
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Corresponding author

Correspondence to Michael Golatta.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the University of Heidelberg ethics committee (S-468/2016) and in accordance with the Declaration of Helsinki.

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Patient consent was waived as the study did not interfere with standard-of-care nor did it disclose or analyze protected health information.

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Funk, A., Heil, J., Harcos, A. et al. Efficacy of intraoperative specimen radiography as margin assessment tool in breast conserving surgery. Breast Cancer Res Treat 179, 425–433 (2020). https://doi.org/10.1007/s10549-019-05476-6

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