title: High resolution intra-operative two-dimensional specimen mammography and its impact on second operation for re-excision of positive margins at final pathology after breast conservation surgery.
abstract: BACKGROUND
  In the United States, about 50% to 66% of women undergoing breast conservation surgery for cancer undergo subsequent mastectomy for positive margins on initial lumpectomy. This is despite the fact that screening mammography has resulted in a decrease in the size of newly diagnosed breast cancer to <2 cm.
  
  
  METHODS
  A retrospective review of 128 patients who underwent breast conservation surgery for early breast cancer was performed using intraoperative 2-dimensional Faxitron high-resolution specimen mammography without specimen compression as the only margin assessment technique. Of these, 29 patients had histories of lumpectomy with positive margins.
  
  
  RESULTS
  A total of 131 procedures were performed. Margins were histologically clear at initial breast conservation surgery in 84.3% of patients who underwent primary lumpectomy. Subsequent reexcision for positive margins was required in 14.7% of patients. Two-dimensional Faxitron mammographically guided intraoperative reexcision cleared the margins in 95.8% of patients (23 of 24) who would have otherwise required subsequent reexcision.
  
  
  CONCLUSIONS
  Intraoperative 2-dimensional Faxitron high-resolution specimen mammography can decrease rates of margin positivity and has the potential to diminish the number of subsequent undesired mastectomies for positive margins.
authors.affiliation: Department of Surgery, Creighton University Medical Center, Omaha, NE, USA. bathlalok@gmail.com
authors.forename: Lokesh
authors.initials: L
authors.lastname: Bathla
authors.forename: Ann
authors.initials: A
authors.lastname: Harris
authors.forename: Mary
authors.initials: M
authors.lastname: Davey
authors.forename: Poonam
authors.initials: P
authors.lastname: Sharma
authors.forename: Edibaldo
authors.initials: E
authors.lastname: Silva
mesh_terms: D001706:Biopsy; D001940:Breast / Q000473:pathology / Q000601:surgery*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008327:Mammography / Q000379:methods*; D015412:Mastectomy, Segmental; D012086:Reoperation; D012189:Retrospective Studies; D013048:Specimen Handling