INTRAOPERATIVE SPECIMEN ULTRASONOGRAPHY TO DETECT MARGINS IN BREAST CONSERVING SURGERY FOR NON-PALPABLE LESIONS AND COMPARISON WITH SPECIMEN MAMMOGRAPHY: ANALYSIS OF 132 CONSECUTIVE CASES sendhil1986@gmail.com

 

INTRAOPERATIVE SPECIMEN ULTRASONOGRAPHY TO DETECT MARGINS IN BREAST CONSERVING SURGERY FOR NON-PALPABLE LESIONS AND COMPARISON WITH SPECIMEN MAMMOGRAPHY: ANALYSIS OF 132 CONSECUTIVE CASES

5

United Kingdom

Oral or Poster

Intra-operative specimen ultrasonography(SU) has been proposed as a cost effective tool to confirm clear margins during breast conserving surgery. We aimed to evaluate the reliability of SU to detect clear radial margins in patients undergoing wide local excision(WLE) for non-palpable lesions and compare SU with Specimen Mammography(SM).

This retrospective analysis included all patients who underwent WLE with SU and SM for invasive breast cancer and mass-forming DCIS between 2018-2022 at a tertiary care hospital. After WLE, SU was performed by the operating surgeon and reported as clear, or close margin(<10mm); and the results were compared with SM & pathological radial margins.

137 lesions(132 patients) were included. Median age was 66 years; most patients(67.5%) were screen-detected. 128 patients(97%) had unifocal disease. The majority of tumours were invasive ductal, no special type(79%) and Grade 1/2(68%), the median tumour size was 15mm. A total of 548 SU/SM radial margins was recorded for 137 tumours. A total of 22/548 radial margins were positive (19/137 specimens). SM had a slightly higher sensitivity than SU, however this was reflective in just one additional specimen where SM identified a close margin and SU did not. SU had a sensitivity & specificity of 68.2% & 96.9%, comparable with SM(72.7% & 96.4%), p=0.6115/1.000.

In the largest series till date for non-palpable lesions, SU was a quick and reliable method to assess WLE margins with an overall accuracy of 82.5%, equivalent to SM. This will have maximal use in centres that do not have SM facilities and in resource-limited settings.