Localization Procedures to Assist Surgeons Performing Breast-Conserving Surgery

Patients with non-palpable breast cancers:
- Require localization procedures (either with wires or other devices) to assist surgeons performing breast-conserving surgery
- Documentation of removal is considered the standard of care:
  - Regardless of the method of localization:
    - This documentation can be accomplished with:
      - Specimen mammography and/or intraoperative ultrasound
- Compression of the specimen does not result in improved accuracy of detection:
  - Leads to reduction in specimen volume and dimensions:
    - This can result in the “pancake phenomenon,”:
      - In which flattening of the specimen leads to the presence of ink within the crevices of the specimen:
        Resulting in positive margins
        This phenomenon is independent of age of the patient, breast density, and type of lesion (mass vs calcifications)
Reviews comparing accuracy of the specimen mammogram to predict the presence of negative margins:
- Have shown poor results (32% negative predictive value):
  - However, tumor extending to the edge of the specimen on mammogram does correlate with histologic margins:
    - With 98% predictive value
References
Performance and practice guidelines for breast-conserving surgery/partial mastectomy. American Society of Breast Surgeons. Version 2.2015. https://www.breastsurgeons.org/statements/guidelines/PerformancePracticeGuidelines_Breast-ConservingSurgery-PartialMastectomy.pdf. Accessed September 19, 2019.
Mendez, JE, ter Meulen D, Padussis J, et al. Tissue compression is not necessary for needle-localized lesion identification. Amer J Surg. 2005;190(4):580-582.
Graham RA, Homer MJ, Katz J, Rothschild J, Safaii H, Supran S. The pancake phenomenon contributes to the inaccuracy of margin assessment in patients with breast cancer. Am J Surg. 2002;184(2):89-93.
Graham RA, Homer MJ, Sigler CJ et al. The efficacy of specimen radiography in evaluating the surgical margins of impalpable breast carcinoma. AJR Am J Roentgenol. 1994;162(1):33-36.