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Digital Breast Tomosynthesis for Intraoperative Margin Assessment during Breast-Conserving Surgery

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Intraoperative margin assessment for breast cancer patients undergoing segmental mastectomy (SM) enables identification of positive margins, with immediate excision of additional tissue to obtain negative margins.

Objective

The aim of this study was to determine the ability of digital breast tomosynthesis (DBT) to detect positive margins compared with an institution’s standard extensive processing (SEP).

Methods

SM specimens underwent intraoperative SEP with two-dimensional (2D) imaging of the intact and sliced specimen, with review by a breast radiologist and gross assessment by a breast pathologist. Findings guided the surgeon to excise additional tissue. DBT images of intact specimens were prospectively obtained and retrospectively reviewed by a breast radiologist. A positive margin was defined as tumor at ink.

Results

Ninety-eight patients underwent 99 SMs. With SEP, 14 (14%) SM specimens had 19 positive margins. SEP did not detect 3 of the 19 positive margins, for a sensitivity of 84%, specificity of 78%, positive predictive value (PPV) of 11%, and negative predictive value (NPV) of 99%. Moreover, DBT did not detect 5 of the 19 positive margins, for a sensitivity of 74% (p > 0.05), specificity of 91% (p < 0.05), PPV of 21.5%, and NPV of 99%. With SEP guidance to excise additional tissue, six cases had final positive margins, with SEP not identifying three of these cases and DBT not identifying two. Pathology from the second surgery of these patients showed either no additional malignancy or only focal ductal carcinoma in situ.

Conclusions

DBT is an accurate method for detecting positive margins in breast cancer patients undergoing SM, performing similar to institutional labor-intensive, intraoperative standard processing.

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Acknowledgment

The authors would like to thank Arnold Dahay, Davis Parambil, and Koreene Rockwood, histopathology technicians, for their contribution in processing the specimens for this study.

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Author notes

  1. Wei Wei MS

    Present address: Taussig Cancer Institute, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA

  2. Ko Un Park MD

    Present address: Department of Surgery, Division of Surgical Oncology, The Ohio State University, Columbus, OH, USA

Authors and Affiliations

  1. Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Ko Un Park MD, Henry M. Kuerer MD, PhD & Dalliah M. Black MD

  2. Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Gaiane M. Rauch MD, PhD & Jessica W. T. Leung MD

  3. Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Aysegul A. Sahin MD

  4. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Wei Wei MS & Yisheng Li PhD

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  1. Ko Un Park MD
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Corresponding author

Correspondence to Dalliah M. Black MD.

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Disclosure

Wei Wei’s work was generously supported by The Cancer Centre Support Grant from National Institute for Health/National Cancer Institute grant P30CA016672. Ko Un Park, Henry M. Kuerer, Gaiane M. Rauch, Jessica W. T. Leung, Aysegul A. Sahin, Yisheng Li, and Dalliah M. Black have no relevant financial disclosures to declare.

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Park, K., Kuerer, H.M., Rauch, G.M. et al. Digital Breast Tomosynthesis for Intraoperative Margin Assessment during Breast-Conserving Surgery. Ann Surg Oncol 26, 1720–1728 (2019). https://doi.org/10.1245/s10434-019-07226-w

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  • DOI: https://doi.org/10.1245/s10434-019-07226-w

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