High resolution intra-operative two-dimensional specimen mammography and its impact on second operation for re-excision of positive margins at final pathology after breast conservation surgery

Lokesh Bathla, Ann Harris, Mary Davey, Poonam Sharma, Edibaldo Silva-Lopez

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47 Citations (Scopus)

Abstract

BACKGROUND: In the United States, about 50% to 66% of women undergoing breast conservation surgery for cancer undergo subsequent mastectomy for positive margins on initial lumpectomy. This is despite the fact that screening mammography has resulted in a decrease in the size of newly diagnosed breast cancer to <2 cm. METHODS: A retrospective review of 128 patients who underwent breast conservation surgery for early breast cancer was performed using intraoperative 2-dimensional Faxitron high-resolution specimen mammography without specimen compression as the only margin assessment technique. Of these, 29 patients had histories of lumpectomy with positive margins. RESULTS: A total of 131 procedures were performed. Margins were histologically clear at initial breast conservation surgery in 84.3% of patients who underwent primary lumpectomy. Subsequent reexcision for positive margins was required in 14.7% of patients. Two-dimensional Faxitron mammographically guided intraoperative reexcision cleared the margins in 95.8% of patients (23 of 24) who would have otherwise required subsequent reexcision. CONCLUSIONS: Intraoperative 2-dimensional Faxitron high-resolution specimen mammography can decrease rates of margin positivity and has the potential to diminish the number of subsequent undesired mastectomies for positive margins.

Original languageEnglish (US)
Pages (from-to)387-394
Number of pages8
JournalAmerican journal of surgery
Volume202
Issue number4
DOIs
StatePublished - Oct 2011

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Mammography
Breast
Segmental Mastectomy
Pathology
Mastectomy
Breast Neoplasms
Margins of Excision
Neoplasms

Keywords

  • Failed breast conservation
  • Intraoperative margin assessment
  • Reexcision rates
  • Specimen mammography

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "High resolution intra-operative two-dimensional specimen mammography and its impact on second operation for re-excision of positive margins at final pathology after breast conservation surgery",
abstract = "BACKGROUND: In the United States, about 50{\%} to 66{\%} of women undergoing breast conservation surgery for cancer undergo subsequent mastectomy for positive margins on initial lumpectomy. This is despite the fact that screening mammography has resulted in a decrease in the size of newly diagnosed breast cancer to <2 cm. METHODS: A retrospective review of 128 patients who underwent breast conservation surgery for early breast cancer was performed using intraoperative 2-dimensional Faxitron high-resolution specimen mammography without specimen compression as the only margin assessment technique. Of these, 29 patients had histories of lumpectomy with positive margins. RESULTS: A total of 131 procedures were performed. Margins were histologically clear at initial breast conservation surgery in 84.3{\%} of patients who underwent primary lumpectomy. Subsequent reexcision for positive margins was required in 14.7{\%} of patients. Two-dimensional Faxitron mammographically guided intraoperative reexcision cleared the margins in 95.8{\%} of patients (23 of 24) who would have otherwise required subsequent reexcision. CONCLUSIONS: Intraoperative 2-dimensional Faxitron high-resolution specimen mammography can decrease rates of margin positivity and has the potential to diminish the number of subsequent undesired mastectomies for positive margins.",
keywords = "Failed breast conservation, Intraoperative margin assessment, Reexcision rates, Specimen mammography",
author = "Lokesh Bathla and Ann Harris and Mary Davey and Poonam Sharma and Edibaldo Silva-Lopez",
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AU - Sharma, Poonam

AU - Silva-Lopez, Edibaldo

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N2 - BACKGROUND: In the United States, about 50% to 66% of women undergoing breast conservation surgery for cancer undergo subsequent mastectomy for positive margins on initial lumpectomy. This is despite the fact that screening mammography has resulted in a decrease in the size of newly diagnosed breast cancer to <2 cm. METHODS: A retrospective review of 128 patients who underwent breast conservation surgery for early breast cancer was performed using intraoperative 2-dimensional Faxitron high-resolution specimen mammography without specimen compression as the only margin assessment technique. Of these, 29 patients had histories of lumpectomy with positive margins. RESULTS: A total of 131 procedures were performed. Margins were histologically clear at initial breast conservation surgery in 84.3% of patients who underwent primary lumpectomy. Subsequent reexcision for positive margins was required in 14.7% of patients. Two-dimensional Faxitron mammographically guided intraoperative reexcision cleared the margins in 95.8% of patients (23 of 24) who would have otherwise required subsequent reexcision. CONCLUSIONS: Intraoperative 2-dimensional Faxitron high-resolution specimen mammography can decrease rates of margin positivity and has the potential to diminish the number of subsequent undesired mastectomies for positive margins.

AB - BACKGROUND: In the United States, about 50% to 66% of women undergoing breast conservation surgery for cancer undergo subsequent mastectomy for positive margins on initial lumpectomy. This is despite the fact that screening mammography has resulted in a decrease in the size of newly diagnosed breast cancer to <2 cm. METHODS: A retrospective review of 128 patients who underwent breast conservation surgery for early breast cancer was performed using intraoperative 2-dimensional Faxitron high-resolution specimen mammography without specimen compression as the only margin assessment technique. Of these, 29 patients had histories of lumpectomy with positive margins. RESULTS: A total of 131 procedures were performed. Margins were histologically clear at initial breast conservation surgery in 84.3% of patients who underwent primary lumpectomy. Subsequent reexcision for positive margins was required in 14.7% of patients. Two-dimensional Faxitron mammographically guided intraoperative reexcision cleared the margins in 95.8% of patients (23 of 24) who would have otherwise required subsequent reexcision. CONCLUSIONS: Intraoperative 2-dimensional Faxitron high-resolution specimen mammography can decrease rates of margin positivity and has the potential to diminish the number of subsequent undesired mastectomies for positive margins.

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KW - Reexcision rates

KW - Specimen mammography

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