Surgical Margins Status Assessment After Breast Conserving Surgery: Is There a Difference Between Surgeon and Radiologist Evaluation?

Abstract

Background: The aim of this study is to evaluate the accuracy of intra-operative specimen mammography (ISM) in surgical margins status assessment and highlight the concordance between the interpretations of the surgeon and the radiologist. Methods: Our cross-sectional study included 130 patients with early breast cancer, surgically treated between October 2013 and September 2017 in the multidisciplinary breast center of the A.O.U. City of Health and Science (which is a complex of several hospitals) in Turin, Italy. All recruited patients underwent breast conservative surgery. Surgical margins were evaluated intraoperatively, using intra-operative specimen mammography. A standard compression intra-operative specimen mammography was obtained by the surgeon using the dedicated radiological equipment (Faxitron®, BioVision). After the surgeon’s evaluation of the margins, Faxitron images were sent to PACS. All ISMs images were analyzed by the same specialized radiologist in remote access to confirm the surgeon evaluation. We used kappa formula to report concordance. Results: The discordance rate of positive readings between the surgeon and the radiologist was 5.3% while that of negative readings was 6.9%. The concordance rate between radiologist and pathologist assessments was 100%. Intra-operative specimen mammography specificity was 94% (95% CI: 88–97), and sensitivity was 47% (95% CI: 38–56), with PPV found to be 53% (95% CI: 95% 44-62) and NPV determined to be 92% (95% CI: 86–96), when the assessment was made by the surgeon. Conclusion: Intra-operative specimen mammography is a helpful tool to identify infiltrated margins and to reduce the rate of secondary surgeries by recommending targeted re-excisions of corresponding orientations in order to obtain a final negative margin status. In our experience, not only radiologists but also surgeons could correctly read Faxitron® intra-operative specimen mammography.

Keywords

• Breast cancer
• Mammography
• Intra-operative imaging
• Faxitron
• Lumpectomy