Comparison of Standard and Vacuum Specimen Mammography in the Detection of Margin Status in Conservative Surgery for Breast Cancer: a Cross-Sectional Diagnostic Study Margin detection with specimen mammography
Abstract
Background: One of the most important factors that increases breast cancer (BC) recurrence after Breast-conserving surgery (BCS) is the positivity of the margins, which is found in permanent histological exams. Intra-operative specimen mammography (SM) can reduce the rate of margin positivity and re-operation. Our aim was to examine whether vacuum SM (VSM) is more accurate than standard SM (SSM) in detecting the positivity of the margins.
Methods: For this cross-sectional study, in the operating room, excised specimens of 55 women with breast cancer who underwent lumpectomy were oriented by metallic staples and sutures for radiologic and histological assessment, respectively. In the radiology ward, SSM was first taken; then, the specimen was vacuum packed and VSM was performed. Afterwards, the specimen was sent for histopathological analysis as a gold standard for the assessment of surgical margins. Specimens’ margins were classified according to the size of clear margins in millimeters as zero or >0; and ≤1 or >1.
Results: The mean age of all participants was 51.22 ± 10.58 years. Totally, 220 margins were assessed. According to classified margins (zero and 1 mm), for the detection of affected margins, the accuracy values of the VSM method were 90.52%, and 87.20% while these figures were 91.51% and 88.68% for SSM. There was substantial agreement between the two methods of detecting the affected margins (VSM and SSM), with Cohen's κ =0.66, 95% CI: 0.34-0.97, P-value <0.001). Finally, there was not a statistically significant difference in the proportion of detecting margin between SSM and VSM (McNemar test P-value =0.63).
Conclusion: Specimen mammography with an adequate orientation of the tissue is an accurate and practical method for immediate intraoperative examination of the margin status in BCS, and VSM is not superior to SSM in the detection of affected margins.
Full text article
References
Aziz D, Rawlinson E, Narod SA, Sun P, Lickley HLA, McCready DR, et al. The role of reexcision for positive margins in optimizing local disease control after breast‐conserving surgery for cancer. Breast J. 2006;12(4):331-7. doi: 10.1111/j.1075-122X.2006.00271.x.
Nunez A, Jones V, Schulz-Costello K, Schmolze D. Accuracy of gross intraoperative margin assessment for breast cancer: experience since the SSO-ASTRO margin consensus guidelines. Sci Rep. 2020;10(1):17344. doi: 10.1038/s41598-020-74373-6.
Pataky R, Baliski C. Reoperation costs in attempted breast-conserving surgery: a decision analysis. Curr Oncol. 2016;23(5):314-21. doi: 10.3747/co.23.2989.
Grant Y, Al-Khudairi R, St John E, Barschkett M, Cunningham D, Al-Mufti R, et al. Patient-level costs in margin re-excision for breast-conserving surgery. Br J Surg. 2019;106(4):384-94. doi: 10.1002/bjs.11050.
Funk A, Heil J, Harcos A, Gomez C, Stieber A, Junkermann H, et al. Efficacy of intraoperative specimen radiography as margin assessment tool in breast conserving surgery. Breast Cancer Res Treat. 2020;179:425-33. doi: 10.1007/s10549-019-05476-6.
Baù MG, Surace A, Gregori G, De Sanctis C, Marra V, Marengo C, et al. Vacuum intraoperative specimen mammography: A novel technique. Eur J Obstet Gynecol Reprod Biol. 2020;253:1-6. doi: 10.1016/j.ejogrb.2020.07.004.
Tavakol M, Omranipour R, Alipour S. A Fast and Cheap Method for Orienting Breast Lumpectomy Surgical Samples Before Specimen Mammography. Indian J Surg Oncol. 2023:14;601-2. doi: 10.1007/s13193-023-01718-8.
Schwarz J, Schmidt H. Technology for intraoperative margin assessment in breast cancer. Ann Surg Oncol. 2020;27:2278-87.
Reid VJ, Falk JS, Police AM, Ridgeway CA, Cadena LL, Povoski SP. Minimizing re-excision after breast conserving surgery–a review of radiofrequency spectroscopy for real-time, intraoperative margin assessment. Expert Rev Med Devices. 2021;18(11):1057-68. doi: 10.1080/17434440.2021.1992273.
Bathla L, Harris A, Davey M, Sharma P, Silva E. 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. Am J Surg. 2011;202(4):387-94. doi: 10.1016/j.amjsurg.2010.09.031.
St John ER, Al-Khudairi R, Ashrafian H, Athanasiou T, Takats Z, Hadjiminas DJ, et al. Diagnostic accuracy of intraoperative techniques for margin assessment in breast cancer surgery. Ann Surg. 2017;265(2):300-10. doi:10.1097/SLA.0000000000001897.
Nowikiewicz T, Śrutek E, Głowacka-Mrotek I, Tarkowska M, Żyromska A, Zegarski W. Clinical outcomes of an intraoperative surgical margin assessment using the fresh frozen section method in patients with invasive breast cancer undergoing breast-conserving surgery–a single center analysis. Sci Rep. 2019;9(1):13441. doi: 10.1038/s41598-019-49951-y.
Cabioglu N, Hunt KK, Sahin AA, Kuerer HM, Babiera GV, Singletary SE, et al. Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol. 2007;14:1458-71. doi: 10.1245/s10434-006-9236-0.
Jin M, Kim JY, Kim TH, Kang DK, Han SH, Jung Y. Intraoperative specimen mammography for margin assessment in breast-conserving surgery. J Breast Cancer. 2019;22(4):635-40. doi: 10.4048/jbc.2019.22.e58.
Iqbal F, Tafazal H, Salem F, Vidya R. Specimen Orientation in Breast Conserving Surgery: An Argument for using Specimen Kits. Arch Can Res. 2017;5(3):151. doi: 10.21767/2254-6081.1000151.
Tucker AW, Calliste J, Gidcumb EM, Wu J, Kuzmiak CM, Hyun N, et al. Comparison of a stationary digital breast tomosynthesis system to magnified 2D mammography using breast tissue specimens. Acad Radiol. 2014;21(12):1547-52. doi: 10.1016/j.acra.2014.07.009.
McCormick JT, Keleher AJ, Tikhomirov VB, Budway RJ, Caushaj PF. Analysis of the use of specimen mammography in breast conservation therapy. Am J Surg. 2004;188(4):433-6. doi: 10.1016/j.amjsurg.2004.06.030.
Dixon J, Sekar OR, Walsh J, Paterson D, Anderson T. Specimen-orientated radiography helps define excision margins of malignant lesions detected by breast screening. Br J Surg. 1993;80(8):1001-2. doi: 10.1002/bjs.1800800822.
Akbari M, Akbari M, Zirakzadeh H, Nafissi N, Heidari A, Shirazi FH. Margin status influence on the outcome of patients treated with breast conserving surgery. Iran J Cancer Prev. 2011;4(4):177-82.
Ihrai T, Quaranta D, Fouche Y, Machiavello J-C, Raoust I, Chapellier C, et al. Intraoperative radiological margin assessment in breast-conserving surgery. Eur J Surg Oncol. 2014;40(4):449-53. doi: 10.1016/j.ejso.2014.01.002.
Keating J, Tchou J, Okusanya O, Fisher C, Batiste R, Jiang J, et al. Identification of breast cancer margins using intraoperative near‐infrared imaging. J Surg Oncol. 2016;113(5):508-14. doi: 10.1002/jso.24167.
Haka AS, Volynskaya Z, Gardecki JA, Nazemi J, Lyons J, Hicks D, et al. In vivo margin assessment during partial mastectomy breast surgery using Raman spectroscopy. Cancer Res. 2006;66(6):3317-22. doi: 10.1158/0008-5472.CAN-05-2815.
Kulkarni SA, Kulkarni K, Schacht D, Bhole S, Reiser I, Abe H, et al. High-resolution full-3D specimen imaging for lumpectomy margin assessment in breast cancer. Ann Surg Oncol. 2021;28:5513-24. doi: 10.1245/s10434-021-10499-9.
Keating JJ, Fisher C, Batiste R, Singhal S. Advances in intraoperative margin assessment for breast cancer. Curr Surg Rep. 2016;4:1-8. doi: 10.1007/s40137-016-0136-3.
Authors
Copyright (c) 2023 Archives of Breast Cancer
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright©. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International License, which permits copy and redistribution of the material in any medium or format or adapt, remix, transform, and build upon the material for any purpose, except for commercial purposes.