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Effect of intraoperative in-room specimen radiography on margin status in breast-conserving surgery
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Effect of intraoperative in-room specimen radiography on margin status in breast-conserving surgery
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Effect of intraoperative in-room specimen radiography on margin status in breast-conserving surgery
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Journal Article
Effect of intraoperative in-room specimen radiography on margin status in breast-conserving surgery
2022
Overview
Background: Intraoperative in-room specimen radiography (IRSR) allows for immediate in-theatre mammographic determination of specimen margin status in breast-conserving surgery (BCS) for breast cancer. It has been demonstrated to be equivalent or superior to the traditional specimen radiography (SR) in detecting margin positivity. This retrospective study aimed to examine the impact of replacing SR with IRSR at a tertiary institution on positive margin rates, reoperation rates, and excised volume of wire-localized BCS. Methods: Our study reviewed 794 consecutive BCS with wire-localization identified from a prospectively maintained database at a breast centre in Canada from January 2017 to December 2019. The effect of IRSR compared with SR on positive margin and reoperation rates were evaluated using univariate regression, while excised tissue volumes were evaluated using linear regression. Results: The analysis demonstrated no statistically significant reduction in overall positive margin rates, reoperation rates, and excised tissue volume in wire-localized BCS after the introduction of IRSR. However, there was a trend toward reduction in close (< 2 mm) or positive margin rates (odds ratio [OR] 0.61, 95% confidence interval [CI] 0.33-1.12, p = 0.11), and reoperation rates (OR 0.61, 95% CI 0.32-1.14, p = 0.12) in patients whose lumpectomy showed pure ductal carcinoma in situ (DCIS). A statistically significant reduction in reoperation rates (OR 0.45, 95% CI 0.23-0.86, p = 0.019) in patients who underwent preoperative stereotactic biopsy was also noted. Statistically significant increased excised tissue volume with IRSR was found in patients with invasive cancers. Conclusion: Our study revealed that IRSR at our centre correlated with a trend toward decreased margin positivity and reoperations in the DCIS subgroup, with corresponding statistically significant reduction in reoperations of breast cancers confirmed on stereotactic biopsy, the modality often used for sampling of calcifications most common in DCIS. Further study is needed to elucidate the increase in excised tissue volume.
Publisher
CMA Impact, Inc
Subject
