title: Does three-dimensional intraoperative specimen imaging reduce the need for re-excision in breast cancer patients? A prospective cohort study.
abstract: BACKGROUND
  Standard two-dimensional (2D) specimen radiography may guide intraoperative re-excision of margins in patients undergoing breast conserving surgery. We sought to determine the impact of three-dimensional (3D) specimen imaging in further reducing positive margin rates.
  
  
  METHODS
  A prospective study of 100 patients in which both 2D and 3D specimen radiographies were performed. The impact of orthogonal view on intraoperative surgical management and final margins was assessed.
  
  
  RESULTS
  Ten patients had no residual tumor; therefore, 90 patients formed the cohort of interest. Of them, 21 patients (23.3%) had ductal carcinoma in situ; 18 (20.0%) had invasive cancer; and 51 (56.7%) had both. Median tumor size was 1.7 cm (range, .2 to 8.1 cm). On the basis of 2D imaging, surgeons stated they would take more tissue in 26 patients (28.9%). Three-dimensional imaging changed management in 4 patients (6.3%). One of these patients would have had positive margins if the intraoperative resection done on the basis of the 3D imaging would have been omitted.
  
  
  CONCLUSIONS
  Three-dimensional specimen imaging results in further intraoperative re-excision in 6.3% of patients and may reduce re-excision rates in 2.2%.
authors.affiliation: Department of Surgery, Yale University School of Medicine, 20 York Street, New Haven, CT 06510, USA. Electronic address: anees.chagpar@yale.edu.
authors.forename: Anees B
authors.initials: AB
authors.lastname: Chagpar
authors.affiliation: Department of Surgery, Yale University School of Medicine, 20 York Street, New Haven, CT 06510, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Butler
authors.affiliation: Department of Surgery, Yale University School of Medicine, 20 York Street, New Haven, CT 06510, USA.
authors.forename: Brigid K
authors.initials: BK
authors.lastname: Killelea
authors.affiliation: Department of Surgery, Yale University School of Medicine, 20 York Street, New Haven, CT 06510, USA.
authors.forename: Nina R
authors.initials: NR
authors.lastname: Horowitz
authors.affiliation: Department of Surgery, Yale University School of Medicine, 20 York Street, New Haven, CT 06510, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Stavris
authors.affiliation: Department of Surgery, Yale University School of Medicine, 20 York Street, New Haven, CT 06510, USA.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Lannin
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007430:Intraoperative Care; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation
keywords: Breast conservation; Margins; Specimen radiography; Surgery