Two-thirds of women experienced a significant reduction of pain when the radiolucent cushions were used during mammography. Pain reduction was accomplished without any clinically significant change in compression force, radiation dose values, or image quality.
Body: BACKGROUND: Specimen mammography aids in the determination 1) if the target lesion has been removed and 2) whether there is a clear margin at excision. In the past, two orthogonal views using 2-D imaging has been considered to be equivalent to a three dimensional perspective. Yet tomosynthesis for screening mammography has demonstrated the value of thin sliced imaging over two view screening mammography. In March, 2015, we began using true 3-D tomosynthesis of breast specimens at lumpectomy and have compared 2-D and 3-D specimen mammography. •METHODS: We have examined 125 consecutive breast cancer patients with both 2-D and 3-D imaging of the same specimens since March 2015. The circulating nurse would take the specimen and obtain two orthogonal views using both 2-D and 3-D devices with images sent to the radiology department. It was not felt ethical to blind the surgeon from having both images available to make an intraoperative clinical decision regarding immediate re-excision. We compared the data noted from each method and which method best aided the decision to perform immediate re-excision, and time required to obtain the images. •RESULTS: We have studied 125 patients over 11 months since March 2015. Confirmation of complete lesion excision was easier with 3-D tomosynthesis than with 2-D as the 3-D slice did not include overlying skin or dense breast tissue surrounding the lesion in the image, making the target lesion stand out more clearly. Although the 2-D images may appear to have higher contrast than the individual 3-D slices, the tomosynthesis 3-D images contained more actionable data than the 2-D. Also decisions to excise more tissue during the procedure were enabled by the additional information included in the 3-D images. In addition, the 3-D images provided the depth of field to enable accurate re-excision using the Z-axis (see figures). Finally, it took about a minute longer to obtain and review the 3D images, although this difference did not delay surgical decisions nor prolong operative time. •CONCLUSIONS: 3-D specimen tomosynthesis facilitates the reduction of postoperative re-excision for lumpectomy patients by providing more information than 2-D orthogonal views, providing easier, more accurate confirmation of the extent of the target excision. Additionally, serial 1mm slices of the specimen allowed the integration of Z-axis targeting, ensuring that any necessary margin excision during surgery was accomplished immediately with maximum tissue conservation. More studies are planned to further validate these findings of these first 125 patients.
Background Over 266,000 women are newly diagnosed with breast cancer every year in the United States, roughly 21% of women die of the disease annually.[1] Many studies have been conducted to evaluate how delays in diagnosis and treatment can result in adverse patient outcomes. Factors including tumor size and stage, socioeconomic status, race/ethnicity, and hospital size and capabilities have been shown to influence outcomes. Variation in care delivery and turnaround times can be reduced by accurately examining the patient care path from initial screening mammography to first surgical intervention. We have developed a process to optimize timeliness to initial surgical treatment. Methods The process starts with observing care delivery from diagnostic mammogram, biopsy, pathology tissue processing, diagnosis and lumpectomy or mastectomy. A team of process and clinical experts (Leica Biosystems) conducted observations to map out current care delivery processes. Standard national metrics for timeliness within the breast care pathway from the National Consortium of Breast Centers' was applied to the process map to understand national averages as well as best practices. Timeliness data on 5,571 patients from over 250 breast centers across the country from the NQMBC (National Quality Measures for Breast Centers) database was utilized to review time intervals and intradepartmental hand offs that impact progression through the breast care pathway. Six sigma, black belt specialists conduct analysis of current breast center processes, identifies specific sites for improvement, integrates their recommendations and completes the cycle by repeat monitoring of the entire process. Results Our specialists have reviewed average and ideal overall performance in timeliness to initial surgical treatment. Improvements may be expected from 22%-75% in timeliness to initial surgical treatment. Turnaround Time (Days) Mean*Best Practice**Time from screening to dx mammo6.04.9Time from dx mamo to bx5.94.1Time from bx to path report2.11.2Time from bx to first surgery22.616.9Total time from screening mammogram to first surgery36.627.1* Mean=average number of business days based on NQMBC data July-Dec. 2017** "Best Practice"=The 75th percentile based on data in NQMBC database July-Dec. 2017 Conclusion A process to impact the timeliness of care between screening mammography and initial surgical treatment has been developed. Standardized and monitored care delivery processes can result in better efficiency in breast cancer patient care delivery from between 22% - 75%. Using a detailed patient care pathway and black belt specialists to analyze processes, we expect to reduce turnaround times and optimize efficiency across the breast cancer patient's care pathway. © 2018 Devicor Medical Products, Inc., part of Leica Biosystems. All rights reserved. LEICA and the Leica logo are registered trademarks of Leica Microsystems IR GmbH. Other logos, product and/or company names might be trademarks of their respective owners. MDM# 18798 Rev 07/18 [1] Cancer Facts and Figures 2018; American Cancer Society Citation Format: Neff K, Kaufman CS. Accurately monitoring by specialist teams reduces the time between breast cancer screening and initial surgical treatment [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-14-05.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.