Use of Tomosynthesis in Intraoperative Digital Specimen Radiography – Is a Reduction of Breast Re-excision Rates Possible?

Abstract

Aim: A prospective clinical study was done to see whether it is possible to reduce the rate of reexcisions using digital breast tomosynthesis (DBT) compared commercial FFDM. Material and Method: Between 1/2011 and 5/ 2011 we diagnosed an invasive breast cancer (BI-RADS 5) in 100 patients. After histological verification we performed breast-conserving therapy with intraoperative imaging using one of 2 different systems: 1.

Predictors of re‐excision in wire‐guided wide local excision for early breast cancer: a Western Australian multi‐centre experience

“…Specimen imaging techniques that improve identification of involved or close tumour margins at the time of initial surgery can help direct immediate intra-operative re-excision, potentially reducing the need for second surgery. Ultra-sound and tomosynthesis enable assessment of macroscopic margins in three dimensions 44,45 and rapidly developing techniques such as near infrared fluorescence optical imaging and optical coherence tomography may allow microscopic identification of involved or close tumour margins. 46…”

Full Field Digital Mammography (FFDM) versus CMOS Technology versus Tomosynthesis (DBT) - Which System Increases the Quality of Intraoperative Imaging?

“…Hierbei gab es ebenfalls eine Innovation von konventionellen, über Speicherfolien zu volldigitalen Systemen [14][15][16][17][18][19][20][21][22] bis hin zur CMOS-Technologie [23] und dem Einsatz der Tomosynthese [24]. Durch die Neuentwicklung der digitalen Brusttomosynthese (DBT) [25][26][27][28][29][30][31][32] besteht nun auch die Möglichkeit der Erstellung intraoperativer Präparateradiogramme [24]. Die 3 Untersucher beurteilten zufallsverteilt (Zufallsgenerator), nur in Kenntnis des Ausgangsbefundes (histologisch Diagnose B5, diagnostisch BI-RADS 6), intraoperativ auf einem Befundungsmonitor die 200 Präparate (Präparateradiografie) mit dem BioVision™-System, 2 Ebenen (System 2) und der Tomosynthese (1 Ebene) einerseits sowohl anhand der Projektionsbilder als auch im Cine-Mode (System 3), wobei als Standard das Präparatera-diogramm in 2 Ebenen (System 1) definiert wurde, aufgrund dessen bei 44 Patientinnen eine Re-Exzision durchgeführt wurde.…”

“…Here too, there has been a gradual switch from conventional systems using slides to fully digital systems [14][15][16][17][18][19][20][21][22] to CMOS technology [23] and Tomosynthesis [24]. The most recent developments in digital breast tomosynthesis (DBT) [25][26][27][28][29][30][31][32] make it possible to create specimen radiograms intraoperatively [24]. The 3 investigating radiologists assessed 200 specimens (specimen radiograms) randomly assigned to them (random generator) with only a prior knowledge of the initial pathology findings (histological classification B5, diagnostic classification BI-RADS 6).…”

Re-excision Rates and Local Recurrence in Breast Cancer Patients Undergoing Breast Conserving Therapy

“…However, no limits have been placed on the number of RE procedures undertaken until mastectomy is advisable. Whether the need for multiple RE procedures is associated with an increased risk of local recurrence (LR) is still controversially discussed [3, [11][12][13]35]. If OPS is done, it is possible to remove larger volumes of up to 20-40 % of the initial breast tissue without compromising the oncologic or esthetic result [14].…”