Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • 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, and 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 #BreastSurgen #CancerSurgeon
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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