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.

#Arrangoiz #BreastSurgeon #CancerSuregeon #SurgicalOncologist #BreastCancer #BreastSurgery #Miami #CASO #Miami #CenterforAdvancedSurgicalOncology

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