Lumpectomy Specimen Radiography: Does Orientation or 3-Dimensional Tomosynthesis Improve Margin Assessment?

Abstract

Purpose Our purpose was twofold. First, we sought to determine whether 2 orthogonal oriented views of excised breast cancer specimens could improve surgical margin assessment compared to a single unoriented view. Second, we sought to determine whether 3D tomosynthesis could improve surgical margin assessment compared to 2D mammography alone. Materials and Methods Forty-one consecutive specimens were prospectively imaged using 4 protocols: single view unoriented 2D image acquired on a specimen unit (1VSU), 2 orthogonal oriented 2D images acquired on the specimen unit (2VSU), 2 orthogonal oriented 2D images acquired on a mammogram unit (2V2DMU), and 2 orthogonal oriented 3D images acquired on the mammogram unit (2V3DMU). Three breast imagers randomly assessed surgical margin of the 41 specimens with each protocol. Surgical margin per histopathology was considered the gold standard. Results The average area under the curve (AUC) was 0.60 for 1VSU, 0.66 for 2VSU, 0.68 for 2V2DMU, and 0.60 for 2V3DMU. Comparing AUCs for 2VSU vs 1VSU by reader showed improved diagnostic accuracy using 2VSU; however, this difference was only statistically significant for reader 3 (0.73 vs 0.63, P = .0455). Comparing AUCs for 2V3DMU vs 2V2DMU by reader showed mixed results, with reader 1 demonstrating increased accuracy (0.72 vs 0.68, P = .5984), while readers 2 and 3 demonstrated decreased accuracy (0.50 vs 0.62, P = .1089 and 0.58 vs 0.75, P = .0269). Conclusions 2VSU showed improved accuracy in surgical margin prediction compared to 1VSU, although this was not statistically significant for all readers. 3D tomosynthesis did not improve surgical margin assessment.

Computer Vision Analysis of Specimen Mammography to Predict Margin Status

“…23 AUROC is similarly variable, but low, ranging from 0.60 to 0.73. [23][24][25][26][27] The current models' accuracy metrics are higher than many of the results published in the literature, demonstrating the potential of this approach.…”

Is specimen radiography still necessary in patients with non-palpable breast cancer undergoing breast-conserving surgery using radioactive I-125 seed localization?

“…One could argue that two-dimension or even threedimension would improve margin assessment using SR. However, results so far do not support this statement with still moderate diagnostic performance and one-dimensional SR is used most often in daily practice [39][40][41]. Lastly, diagnostic performance of SR depends on the a-priori probability of a positive margin and since definition of a positive margin varies between institutions, the results of the current study are not applicable for all breast cancer patients treated with BCS.…”

Diagnostic performance of tomosynthesis, digital mammography and a dedicated digital specimen radiography system versus pathological assessment of excised breast lesions

“…The observers had varying years of experience, which may contribute to the interobserver variability and is consistent with a previous report. 29 Furthermore, we could not perform more extensive analysis of the diagnostic accuracy of each method in the evaluation of margins owing to complete primary resection of the lesions without positive margins for malignant lesions. Regardless of these limitations, we analysed a cohort of consecutive patients, which is consistent with and representative of actual clinical practice.…”