Intraoperative digital specimen radiography in the treatment of nonpalpable breast lesions

Abstract

Introduction/Objective About a third of the breast lesions on mammography are clinically occult. The goals of surgical treatment are to locate, remove, and verify their presence in the removed breast tissue. Standard specimen mammography (SSM) has been an official procedure for the latter, while intraoperative digital specimen radiography (IDSR) was introduced recently. The aim of this study was to evaluate the use of IDSR versus SSM and possible benefits regarding the duration of the procedures (operating room occupancy), availability of digital mammography for additional number of patients, surgeon productivity, and the quality of performed services. Methods A retrospective chart review of 109 patients who underwent IDSR for nonpalpable breast lesions was performed between January 2014 and June 2016. We compared the difference in the duration of IDSR versus SSM procedure. We also observed the number of re-excisions and evaluated time-saving in the operating room workflow. Results The average duration of surgery in the IDSR group of patients was 51 minutes, compared to 64 minutes in the SSM group. Every IDSR procedure saved 13 minutes over the standard SSM. That would allow another 28 procedures in the same time frame, with the same quality of service compared with SSM. In that way we increased productivity by 27.5%. Additional operation/surgery was needed for histologically involved surgical margins in three cases (2.75%). Conclusion The use of new technology resulted in the rationalization of the operative room workflow and gave better productivity. More savings were obtained through the increase of digital mammography capacity for diagnostics, decrease of anesthesia duration, and better management of human resources. The number of "true" re-excisions, involving additional surgery, remained similar after introducing IDSR.