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Comparison of margin assessment between intraoperative digital and conventional specimen mammography in breast
Heejung Keum1, Ho Yong Park1, Byeongju Kang1
1Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea.
Insights
Intraoperative digital specimen mammography (IDSM) offers more precise margin assessment in breast-conserving surgery than conventional specimen mammography (CSM). IDSM improves accuracy and reduces operating time by enabling immediate results without specimen compression.
Area of Science:
- Oncology
- Radiology
- Surgical Pathology
Background:
- Specimen imaging aids margin assessment in breast-conserving surgery (BCS).
- Intraoperative digital specimen mammography (IDSM) is a novel technique recently introduced in Korea.
- This study compares IDSM with conventional specimen mammography (CSM) for evaluating margin status.
Purpose of the Study:
- To compare the clinical utility of IDSM versus CSM in breast-conserving surgery.
- To evaluate clinicopathologic factors and diagnostic accuracy between IDSM and CSM.
- To assess the impact of IDSM on surgical workflow and patient outcomes.
Main Methods:
- A comparative study involving 78 breast cancer patients undergoing BCS from October to December 2021.
- Specimens were assessed using either IDSM (n=44) or CSM (n=34).
- Clinicopathologic factors, margin involvement, frozen section biopsy results, and radiation dose were analyzed.
Main Results:
- No significant differences in most clinicopathologic factors were observed between IDSM and CSM groups.
- IDSM demonstrated higher accuracy and sensitivity in detecting margin involvement compared to CSM, primarily due to the absence of compression (p < 0.001).
- The false-negative rate was lower with IDSM, and the closest distance from margin to tumor was slightly longer in the CSM group.
Conclusions:
- Both IDSM and CSM are accurate for evaluating margin involvement in BCS.
- IDSM provides more precise margin assessment due to non-compression of the specimen.
- IDSM's integration into the operating room reduces procedural time and improves workflow efficiency by providing immediate results.
Background:
Although breast surgeons can request frozen section biopsies to evaluate margin status in breast-conserving surgery (BCS), specimen imaging is also a useful assessment tool. Intraoperative digital specimen mammography (IDSM) has recently been introduced in Korea. To estimate the clinical role of IDSM, this study compared the clinicopathologic factors of patients whose specimen was assessed with IDSM with those assessed using conventional specimen mammography (CSM).
Methods:
From October to December 2021, 78 breast cancer patients who underwent BCS were included in this study. The obtained specimens were assessed using IDSM (n = 44) and CSM (n = 34). Clinicopathologic factors included margin involvement status in specimen mammography and the results of frozen section biopsies. The radiation dose emitted from the specimen after mammography was measured using a portable device.
Results:
There were no significant differences in clinicopathological factors between the two groups, except the type of surgery for axillary lymph nodes. The closest distance from the margin to tumor was longer in the CSM group than in the IDSM group, although the difference was not statistically significant (p = 0.894). Margin involvement was accurately detected using IDSM due to the absence of compression (p < 0.001). In addition, the sensitivity and accuracy of IDSM were higher, and the false-negative rate was lower.
Conclusion:
Both specimen mammography methods were highly accurate in evaluating the margin involvement status. However, the margin status could be examined more precisely using IDSM because the specimen was not compressed to perform the examination. Because the IDSM system was installed in the operating room, it not only shortened performing routes but also reduced the operating time by providing immediate results.
