A prospective pilot study of analysis of surgical margins of breast cancers using high-resolution sonography

To investigate the role of high-resolution specimen sonography (SS) to determine the precise location of the targeted lesion in relation to the six surgical margins; the specimen digital radiography isocenter and the correlation with the rate of re-excision and residual tumour. Freshly excised surgical specimens were scanned by a breast radiologist using a high-frequency linear transducer in a cohort of 25 consecutive women undergoing breast conservation. Sonographic measurements of radial distances from all six margins (superior, inferior, lateral, medial, anterior and posterior) were obtained. Sonographic positive margin status was defined as targeted mass identified <5 mm from the tissue edge. The paired t test was used for statistical comparisons between sonographic and pathological measurements. The median cancer size was 15 mm (range 3.80-42 mm; 95 % CI 9.8-18) on sonography and 16 mm (range 2-60 mm; 95 % CI 15-20) on surgical pathology. SS showed 100 % sensitivity and 59 % specificity in the evaluation of surgical pathology margins. 20 % (5 of 25) patients had positive margins where 60 % were in situ carcinoma. The likelihood of carcinoma at the initial surgical margins was significantly higher in dense breasts (3/6 = 50 % vs 1/17 = 5.8 %; p = 0.04). The deviation of the isocenter of the specimens was found not significant. SS is a valuable tool for identify the cancer within the specimen, and better asses the margins. It is of significant importance in patients with dense breasts where specimen radiography is of limited value.