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Single-Port Robotic-assisted Transaxillary Breast-conserving Surgery: A Prospective, Single-arm, Non-randomized Phase IIa Clinical Trial
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871
Digital Breast Tomosynthesis for Intraoperative Margin Assessment during Breast-Conserving Surgery
Ko Un Park1,2, Henry M Kuerer1, Gaiane M Rauch3
1Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Annals of Surgical Oncology
|March 17, 2019
Summary
Digital breast tomosynthesis (DBT) accurately detects positive margins during breast cancer surgery. This method shows comparable performance to standard extensive processing, improving intraoperative margin assessment for segmental mastectomy patients.
Area of Science:
- Radiology
- Oncology
- Surgical Pathology
Background:
- Intraoperative margin assessment in segmental mastectomy (SM) is crucial for identifying positive margins in breast cancer patients.
- Prompt identification allows for immediate tissue excision to achieve negative margins, optimizing surgical outcomes.
Purpose of the Study:
- To evaluate the efficacy of digital breast tomosynthesis (DBT) in detecting positive margins.
- To compare DBT's performance against the institution's standard extensive processing (SEP) for intraoperative margin assessment during SM.
Main Methods:
- Segmental mastectomy specimens underwent intraoperative standard extensive processing (SEP) with 2D imaging and pathologist review.
- Digital breast tomosynthesis (DBT) images of intact specimens were acquired prospectively and reviewed retrospectively.
- Positive margins were defined as tumor at the inked margin.
Main Results:
- Of 99 SMs, 14% had positive margins detected by SEP (sensitivity 84%, specificity 78%).
- DBT demonstrated a sensitivity of 74% and specificity of 91% for detecting positive margins.
- After additional excision guided by SEP, 6 cases still had positive margins; SEP missed 3, and DBT missed 2.
Conclusions:
- Digital breast tomosynthesis (DBT) is a reliable tool for intraoperative margin assessment in SM for breast cancer.
- DBT performance is comparable to the labor-intensive standard extensive processing (SEP).
- DBT offers a potentially more efficient approach to intraoperative margin assessment.
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