title: Comparison of intra-operative specimen mammography to standard specimen mammography for excision of non-palpable breast lesions: a randomized trial.
abstract: Standard specimen mammography (SSM) is performed in the radiology department after wire-localized excision of non-palpable breast lesions to confirm the presence of the target and evaluate margins. Alternatively, intra-operative specimen mammography (ISM) allows surgeons to view images in the operating room (OR). We conducted a randomized study comparing ISM and SSM. Women undergoing wire-localized excision for breast malignancy or imaging abnormality were randomized to SSM or ISM. For SSM, the specimen was transported to the radiology department for imaging and interpretation. For ISM, the specimen was imaged in the OR for interpretation by the surgeon and sent for SSM. Interpretation time was from specimen leaving OR until radiologist interpretation for SSM and from placement in ISM device until surgeon interpretation for ISM. Procedure and interpretation times were compared. Concordance between ISM and SSM for target and margins was evaluated. 72 patients were randomized, 36 ISM and 36 SSM. Median procedure times were similar, 48.5 (17-138) min for ISM, and 54 (17-40) min for SSM (p = 0.72), likely since specimens in both groups traveled to radiology for SSM. Median interpretation time was significantly shorter with ISM, 1 (0.5-2.0) and 9 (4-16) min for ISM and SSM, respectively (p < 0.0001). Among specimens with ISM and SSM, concordance was 100 % (35/35) for target and 93 % (14/15) for margins. In this randomized trial, use of ISM compared with SSM significantly reduced interpretation times, while accurately identifying the target. This could result in decreased operative costs from shorter OR times with use of ISM.
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Miller
authors.affiliation: Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Coopey
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rafferty
authors.affiliation: Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Gadd
authors.affiliation: Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
authors.affiliation: Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA. mspecht@partners.org.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Specht
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008327:Mammography; D015412:Mastectomy, Segmental; D008875:Middle Aged
keywords: Intra-operative imaging; Lumpectomy; Mammography; Wire localization