Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Surgery, Division of Surgical Oncology, The Ohio State University, Columbus, OH, USA.
Ann Surg Oncol. 2019 Jun;26(6):1720-1728. doi: 10.1245/s10434-019-07226-w. Epub 2019 Mar 14.
Intraoperative margin assessment for breast cancer patients undergoing segmental mastectomy (SM) enables identification of positive margins, with immediate excision of additional tissue to obtain negative margins.
The aim of this study was to determine the ability of digital breast tomosynthesis (DBT) to detect positive margins compared with an institution's standard extensive processing (SEP).
SM specimens underwent intraoperative SEP with two-dimensional (2D) imaging of the intact and sliced specimen, with review by a breast radiologist and gross assessment by a breast pathologist. Findings guided the surgeon to excise additional tissue. DBT images of intact specimens were prospectively obtained and retrospectively reviewed by a breast radiologist. A positive margin was defined as tumor at ink.
Ninety-eight patients underwent 99 SMs. With SEP, 14 (14%) SM specimens had 19 positive margins. SEP did not detect 3 of the 19 positive margins, for a sensitivity of 84%, specificity of 78%, positive predictive value (PPV) of 11%, and negative predictive value (NPV) of 99%. Moreover, DBT did not detect 5 of the 19 positive margins, for a sensitivity of 74% (p > 0.05), specificity of 91% (p < 0.05), PPV of 21.5%, and NPV of 99%. With SEP guidance to excise additional tissue, six cases had final positive margins, with SEP not identifying three of these cases and DBT not identifying two. Pathology from the second surgery of these patients showed either no additional malignancy or only focal ductal carcinoma in situ.
DBT is an accurate method for detecting positive margins in breast cancer patients undergoing SM, performing similar to institutional labor-intensive, intraoperative standard processing.
乳腺癌患者行区段切除术（SM）时进行术中切缘评估，可以识别出阳性切缘，并立即切除额外组织以获得阴性切缘。
本研究旨在比较数字乳腺断层合成技术（DBT）与机构标准广泛处理（SEP）检测阳性切缘的能力。
SM 标本行术中 SEP，对完整和切片标本进行二维（2D）成像，由乳腺放射科医生进行检查，由乳腺病理学家进行大体评估。检查结果指导外科医生切除额外的组织。对完整标本进行前瞻性 DBT 成像，并由乳腺放射科医生进行回顾性分析。肿瘤位于墨水上定义为阳性切缘。
98 例患者行 99 例 SM。SEP 发现 14 例（14%）SM 标本有 19 个阳性切缘。SEP 漏诊了其中 3 个阳性切缘，敏感性为 84%，特异性为 78%，阳性预测值（PPV）为 11%，阴性预测值（NPV）为 99%。此外，DBT 漏诊了 19 个阳性切缘中的 5 个，敏感性为 74%（p>0.05），特异性为 91%（p<0.05），PPV 为 21.5%，NPV 为 99%。SEP 指导切除额外组织后，有 6 例最终为阳性切缘，SEP 漏诊了其中 3 例，DBT 漏诊了其中 2 例。这些患者的二次手术病理显示无额外恶性肿瘤或仅为局灶性导管原位癌。
DBT 是一种准确的检测 SM 乳腺癌患者阳性切缘的方法，与机构内劳动密集型、术中标准处理的效果相当。
