title: Whole-mount pathology of breast lumpectomy specimens improves detection of tumour margins and focality.
abstract: OBJECTIVE
  Technical limitations in conventional pathological evaluation of breast lumpectomy specimens may reduce diagnostic accuracy in the assessment of margin and focality. A novel technique based on whole-mount serial sections enhances sampling while preserving specimen conformation and orientation. The aim of this study was to investigate assessment of focality and margin status by the use of whole-mount serial sections versus simulated conventional sections in lumpectomies.
  
  
  RESULTS
  Two pathologists interpreted whole-mount serial sections and simulated conventional sections for 58 lumpectomy specimens by reporting the closest margin and focality. Measurements were compared by the use of McNemar's chi-squared test. Statistically significant differences were observed in the assignment of both margin positivity (P = 0.014) and multifocality (P = 0.021). A positive margin or multifocal disease was identified by the use of whole-mount serial sections but missed in the simulated conventional assessment in 10.3% and 17.2% of all cases, respectively. There was no case in which a positive margin was detected only in the simulated conventional assessment.
  
  
  CONCLUSIONS
  The whole-mount technique is more sensitive than conventional assessment for identifying a positive margin or multifocal disease in breast lumpectomy specimens. Undersampling in conventional sections was implicated in almost all cases of discordance. The majority of positive margins or secondary foci identified only in whole-mount serial sections concerned in-situ disease.
authors.affiliation: Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.
authors.forename: Gina M
authors.identifier: http://orcid.org/0000-0001-6020-6287
authors.initials: GM
authors.lastname: Clarke
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.|Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Claire M B
authors.initials: CM
authors.lastname: Holloway
authors.affiliation: Department of Pathology, The Scarborough Hospital, Toronto, Ontario, Canada.|Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Judit T
authors.initials: JT
authors.lastname: Zubovits
authors.affiliation: Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.|Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Nofech-Mozes
authors.affiliation: Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.
authors.forename: Kela
authors.initials: K
authors.lastname: Liu
authors.affiliation: Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.
authors.forename: Mayan
authors.initials: M
authors.lastname: Murray
authors.affiliation: Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.
authors.forename: Dan
authors.initials: D
authors.lastname: Wang
authors.affiliation: Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.|Departments of Medical Biophysics and Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Yaffe
mesh_terms: D001940:Breast / Q000473:pathology* / Q000601:surgery; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D000072662:Margins of Excision; D015412:Mastectomy, Segmental; D012680:Sensitivity and Specificity; D013048:Specimen Handling
keywords: breast cancer; lumpectomy; multifocality; surgical margins; whole-mount pathology