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- Title
A Pilot Study Evaluating Shaved Cavity Margins with Micro-Computed Tomography: A Novel Method for Predicting Lumpectomy Margin Status Intraoperatively.
- Authors
Tang, Rong; Coopey, Suzanne B.; Buckley, Julliette M.; Aftreth, Owen P.; Fernandez, Leopoldo J.; Brachtel, Elena F.; Michaelson, James S.; Gadd, Michele A.; Specht, Michelle C.; Koerner, Frederick C.; Smith, Barbara L.
- Abstract
Microscopically clear lumpectomy margins are essential in breast conservation, as involved margins increase local recurrence. Currently, 18-50% of lumpectomies have close or positive margins that require re-excision. We assessed the ability of micro-computed tomography (micro- CT) to evaluate lumpectomy shaved cavity margins ( SCM) intraoperatively to determine if this technology could rapidly identify margin involvement by tumor and reduce re-excision rates. Twenty-five SCM from six lumpectomies were evaluated with a Skyscan 1173 table top micro- CT scanner (Skyscan, Belgium). Micro- CT results were compared to histopathological results. We scanned three SCM at once with a 7-minute scanning protocol, and studied a total of 25 SCM from six lumpectomies. Images of the SCM were evaluated for radiographic signs of breast cancer including clustered microcalcifications and spiculated masses. SCM were negative by micro- CT in 19/25 (76%) and negative (≥2 mm) by histopathology in 19/25 (76%). Margin status by micro- CT was concordant with histopathology in 23/25 (92%). Micro- CT overestimated margin involvement in 1/25 and underestimated margin involvement in 1/25. Micro- CT had an 83.3% positive predictive value, a 94.7% negative predictive value, 83.3% sensitivity, and 94.7% specificity for evaluation of SCM. Evaluation of SCM by micro- CT is an accurate and promising method of intraoperative margin assessment in breast cancer patients. The scanning time required is short enough to permit real-time feedback to the operating surgeon, allowing immediate directed re-excision.
- Subjects
MASSACHUSETTS; TOMOGRAPHY; BREAST tumors; STATISTICAL sampling; PILOT projects; LUMPECTOMY; PREDICTIVE tests; DESCRIPTIVE statistics
- Publication
Breast Journal, 2013, Vol 19, Issue 5, p485
- ISSN
1075-122X
- Publication type
Article
- DOI
10.1111/tbj.12146