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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2019

01-06-2019 | Mastectomy | Breast Oncology

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

Authors: Ko Un Park, MD, Henry M. Kuerer, MD, PhD, Gaiane M. Rauch, MD, PhD, Jessica W. T. Leung, MD, Aysegul A. Sahin, MD, Wei Wei, MS, Yisheng Li, PhD, Dalliah M. Black, MD

Published in: Annals of Surgical Oncology | Issue 6/2019

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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.
Appendix
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Metadata
Title
Digital Breast Tomosynthesis for Intraoperative Margin Assessment during Breast-Conserving Surgery
Authors
Ko Un Park, MD
Henry M. Kuerer, MD, PhD
Gaiane M. Rauch, MD, PhD
Jessica W. T. Leung, MD
Aysegul A. Sahin, MD
Wei Wei, MS
Yisheng Li, PhD
Dalliah M. Black, MD
Publication date
01-06-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07226-w

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