Intraoperative inking is superior to suture marking for specimen orientation in breast cancer

Altman, Ariella M.; Nguyen, Donald H.; Johnson, B. Lamar; Marmor, Schelomo; Klein, Molly; Tuttle, Todd M.; Hui, Jane Yuet Ching

doi:10.1111/tbj.13508

Cited by 6 publications

(6 citation statements)

References 35 publications

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“…This suture technique may lead to confusion between the pathologist and surgeon regarding the orientation of the specimen, thereby resulting in the excision of the wrong surgical margin and leaving behind residual disease [ 15 ]. Intraoperative inking of all margins has been proposed to enhance specimen orientation to guide re-excisions for positive margins [ 17 ]. While the technique of specimen orientation has no effect on the rates of positive margins, intraoperative inking is considered superior to suture orientation for residual disease identification at re-excisions [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Positive Margins in Breast-Conserving Surgery

Abdulla¹,

Rajab²,

Hammad³

et al. 2023

Cureus

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Introduction Breast-conserving surgery (BCS) followed by adjuvant radiotherapy has similar overall survival compared to mastectomy but is associated with higher rates of local recurrence. Positive surgical margins in BCS are the most important predictor of local recurrence. The aim of our study was to assess the risk factors associated with positive margins in women undergoing BCS for breast cancer in order to inform our clinical practice and minimize re-operation rates. Methods Patients with a diagnosis of breast cancer who underwent BCS from January 2013 to January 2021 were identified from our pathology database and included in the study. All patients underwent a lumpectomy with the removal of additional shaved cavity margins. Statistical analysis was used to assess the effect of patient clinical and pathological risk factors on the rate of positive margins. Results One hundred and twenty patients underwent BCS for breast cancer. Twenty-four percent of patients had positive margins. Of the 29 patients that underwent subsequent re-excisions, only 13 (45%) had residual disease in the re-excision specimen. In younger patients, tumors localized in lower quadrants and the presence of extensive intraductal component within invasive breast cancer increased the risk of positive margins. In addition, positive margins were encountered more significantly in patients with ductal carcinoma in situ (DCIS) compared to invasive tumors. Multivariate analysis showed that DCIS and young age were the only factors independently associated with positive margins. Conclusion DCIS and younger patients have a higher rate of positive margins during BCS than invasive breast cancer. For such patients at higher risk of positive margins, excision of cavity shave margins and intraoperative inking may be done to lower positive margin rates. Preoperative review of breast imaging, core biopsies, and counseling of patients about the likelihood of positive margins is important.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Positive Margins in Breast-Conserving Surgery

Abdulla¹,

Rajab²,

Hammad³

et al. 2023

Cureus

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“…Although these procedures may prolong operative time, this disadvantage can be easily counterbalanced by a lower re-operation rate, reduction in waiting lists, healthcare costs, as well as less psychological involvement of patients due to re-operation with the inherent feeling of a previous incomplete resection. The pathologist requires an accurate specimen orientation (by means of clips or suture marking) in order to accomplish a reliable pathological assessment as well as to establish the actual location of the positive margin (27)(28)(29)(30). We have adopted a standard clipping protocol in order to ease both the pathologist's assessment as well as the re-excision procedure, whenever necessary.…”

Section: Discussionmentioning

confidence: 99%

The Margins’ Challenge: Risk Factors of Residual Disease After Breast Conserving Surgery in Early-stage Breast Cancer

Fregatti

Gipponi

Atzori

et al. 2022

In Vivo

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Background/Aim: Clinicopathological features of patients undergoing margin enlargement after lumpectomy for early breast cancer with positive/close excision margins were analyzed in order to define whether a re-operative procedure could have been avoided. Furthermore, a standardized protocol of specimen orientation was adopted in order to optimize both the widening procedure as well as the oncologic outcome. Patients and Methods: A retrospective analysis was performed including pre-, peri-, and post-operative parameters, and a predictive score by means of a multivariate model was developed using all clinically and statistically significant variables associated with residual disease (RD). Results: RD was significantly related to positive tumor margins, hormone receptor negative, HER2-positive, and tumors with high Ki67 proliferation index (p<0.001); the corresponding contribution to the prognostic score was as follows: close margins, 3 points; hormone receptor positive disease, 2 points; low Ki67, 2 points; HER2 negativity, 1 point. In 102 patients with a score >3, only 2 patients (2.0%) had RD, while in 81 patients with a score ≤3, 55 patients (67.9%) had RD (p<0.001). Conclusion: This predictive model might aid in clinical-decision making of patients with positive margins who actually require a widening procedure after intraoperative and/or definitive histology.Breast conserving surgery (BCS) is defined as the resection of breast tumor surrounded by a portion of normal tissue; it represents the worldwide treatment for early-stage breast cancer (Stage I-II or Stage III in selected cases) with longterm survival similar to mastectomy (1). From the operative standpoint, non-palpable lesions usually undergo preoperative localization by means of clip positioning, charcoal, or radioactive seeds peri-tumoral injection; following excision, the tumor bed is marked with four clips placed at the corner points in order to be easily identified for radiation therapy planning. Hence, the breast sample is sent for intraoperative macroscopic assessment, and the margins of excision are inked in order to define the minimal 814 This article is freely accessible online.

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“…Once the lesion is stained and fixed, it can be removed appropriately, usually as an excisional biopsy, however this technique allows for multiple types of biopsies to be performed as normal. The surgical ink used is a sterile dye (Margin Marker ink; Vector Surgical) traditionally used to optimize intraoperative tissue orientation and margin marking [15]. The ink securely adheres to tissue and brightly stains the area for easy recognition by pathologists, therefore aiding in localization during histopathological assessment.…”

Section: Ink Stained Rcm-guided Biopsymentioning

confidence: 99%

Novel Ink - Stained Reflectance Confocal Microscopy Guided Pigmented Skin Lesion Biopsy Technique: Reducing Pathology Sample Bias Through Improved Precision

Łudzik¹,

Lee²,

Witkowsk³

et al. 2022

AnnBiotechnol

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With skin cancer incidence rate steadily increasing each year, melanoma continues to pose a significant public health problem globally. It is well-known that early detection and prevention of melanoma remains the most important intervention for reducing morbidity and mortality, therefore it is imperative to promote innovation that will advance our ability to diagnose melanoma early. Because prognosis and treatment are dependent on the depth of dermal involvement, definitive diagnosis of melanoma can only be made through histopathologic assessment [1]. Thus, appropriate sampling of tissue is critical for the accurate evaluation of melanoma.

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Intraoperative inking is superior to suture marking for specimen orientation in breast cancer

Cited by 6 publications

References 35 publications

Risk Factors for Positive Margins in Breast-Conserving Surgery

Risk Factors for Positive Margins in Breast-Conserving Surgery

The Margins’ Challenge: Risk Factors of Residual Disease After Breast Conserving Surgery in Early-stage Breast Cancer

Novel Ink - Stained Reflectance Confocal Microscopy Guided Pigmented Skin Lesion Biopsy Technique: Reducing Pathology Sample Bias Through Improved Precision

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