Breast Specimen Orientation

Abstract

Lumpectomy specimens are commonly divided into six sides: superficial, deep, superior, inferior, medial, and lateral. Orienting stitches are placed on the specimen during surgery to allow reorientation by pathology. Despite those efforts, specimen disorientation may occur. The aim of this study was to assess the correlation in orientation between surgeons and pathologists. Lumpectomy specimens were routinely oriented. An additional Prolene suture was randomly placed by the surgeon on one side to be localized by pathology. The results were recorded and the disorientation rate calculated. Specimen size and presence of skin and/or muscle were also recorded. There were 122 lumpectomy specimens prospectively entered. Average specimen volume was 95.5 cm(3). Twenty-four specimens had segments of skin or muscle. The additional sutures were evenly divided between the six sides. The overall disorientation rate was 31.1% (95% confidence interval, 23.1-40.2).The side-specific disorientation rates were 43%, 40%, 35%, 29%, 28%, and 14% for the deep, superficial, lateral, medial, superior, and inferior surfaces, respectively (no statistical difference). Presence of skin or muscle on the specimen did not contribute to better orientation. Specimen volumes, however, were highly associated with orientation. Specimens of <20 cm(3) had a disorientation rate of 78%, while larger specimen had a disorientation rate of 20% (p < .001). Specimen orientation with stitches placed on two surfaces is associated with a high disorientation rate. Better orientation techniques are necessary to minimize the specimen disorientation.

Intraoperative Assessment of Final Margins with a Handheld Optical Imaging Probe During Breast-Conserving Surgery May Reduce the Reoperation Rate: Results of a Multicenter Study

“…9,17,18 Shave specimens, which were employed to reduce pathology disorientation and standardize specimen handling procedures, were evaluated with the handheld imaging probe on the final margin (i.e., the true margin or new margin). 19 At least four images per specimen were acquired in regions most suspicious for disease, as identified using the image data. Specimens were marked with sutures or ink to indicate final margin orientation before submission to pathology for standard-of-care gross and histology evaluation.…”

Real-time Imaging of the Resection Bed Using a Handheld Probe to Reduce Incidence of Microscopic Positive Margins in Cancer Surgery

“…(4) If additional tissue was excised, the surgeon used the handheld OCT probe to image the new aspect(s) of the resection bed. (5) All excised tissue specimens were evaluated with the handheld OCT probe in the operating room by the research staff. (6) Specimens were marked with dye at the OCT imaging sites for correlation and returned to the operating room staff for routine histopathological examination by a board-certified pathologist.…”

“…(4) It is also challenging to spatially correlate the analyzed regions on excised specimens with the corresponding locations in the resection bed. (5) As the currently available tools are limited, there is a compelling need to improve upon these existing intraoperative methods to enable real-time microscopic detection of residual disease both within the resection bed and on resected specimens.…”

Optimizing Surgical Margins in Breast Conservation

“…Marking sutures have traditionally been placed on 2 or more of the 6 surfaces of a lumpectomy specimen by the surgeon in the operating room, followed by inking of all 6 margins done by the pathologist in the lab. Molina et al demonstrated that with 2 marking sutures placed by the surgeon, there was a 20% rate of discordance between surgeon and pathologist interpretation of the margins in specimens larger than 20 square cm [65]. In smaller specimens less than 20 square cm, the discordance was as high as 78%.…”