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![Page 1: Final Abstract](https://reader030.fdocuments.net/reader030/viewer/2022032623/55cf9945550346d0339c8665/html5/thumbnails/1.jpg)
Evaluation of Surgical Re-excision Rates with Bioptics Biovision Imaging
Sarah De Los Santos BA, Anita Sambamurty BS,
Anita P. McSwain MD MPH FACS, Christine B. Teal MD FACS
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Purpose
To assess the efficacy of examining specimen margins with Bioptics Biovision imaging to potentially reduce re-excisions for patients undergoing breast
surgical excision by wire localization.
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Introduction• The diagnosis of breast cancer is generally made by
ultrasound or sterotactic guided core needle biopsy.
• When a patient is not amenable to needle biopsy or when pathology shows an abnormal lesion that is not palpable, surgical excision with wire localization is necessary.
• Wire localization is performed in the radiology suite by ultrasound or mammographic guidance.
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Surgical Excision
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Faxitron Bioptics Biovision
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Intaoperative Specimen Verification
• Bioptics Biovision versus Traditional Analog Xray
• Immediate intraoperative digital imaging
• Higher Quality Images
• Portable
• Decreased operating time
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Bioptics BioVision Imaging vs Analog XRay
• 35 patients undergoing excisional biopsies by wire localization
• Bioptics BioVision required less time for specimen radiography
Imaging Modality Range of Time Average Time
Bioptics Biovision 1.3 – 4.0 min 1.9 min
Analogy XRay 12.6 – 19.3 min 15.8 min
Presented at the 13th Annual Meeting of the American Association Society of Breast Surgeons
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Factors Associated with Re-Excision• 351 patients with Early Stage Breast Cancer that were
treated with breast conservation surgery
• 118 patients required RE for close surgical margins• DCIS was present in 77 (65%) of the involved margins
• 211 patients had surgical excision requiring wire localization• 76 patients (36%) of the 211 required re-excision due to close
margins• 39 of the 140 patients (28%) who had palpable tumors required a
secondary re-excision
Printed in The American Surgeon, Vol 76, March 2010
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Methods
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MethodsSuperior
Inferior
MedialLateral
Does NOT assessAnteriorPosterior
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Methods
• Retrospective Chart Review of 127 Breast Excisions by Wire Localization
Variables studiedRe-excision Rates & Pre-operative Diagnosis
• Breast Cancer• Other: Atypia, Papilloma, not amenable to needle biopsy
Positive Margins
• Anterior and Posterior Margins• All other Margins
Additional Margins taken during surgery
• Positive Margins with cancer• Additional Re-excision
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Results: Re-Excision Rates
All Cases Cancer Diagnoses Atypia, Papillomas or Unknown Diagnosis
0
20
40
60
80
100
120
140
Nu
mb
er o
f P
atie
nts
1037
48
Total: 127
Total: 109
Total: 18
38% 34% 55%
Our previous Re-excision rate – 36%
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Positive Margins requiring Re-excision
Anterior Posterior Anterior and Posterior
Other Margins0
5
10
15
20
25
Nu
mb
er o
f P
atie
nts
110 17
Sup = 4
28 of the 48 (58%) patients requiring re-excision had inadequate anterior or posterior margins
21% 35% 2% 42%
Inf = 4
Med = 7
Lat = 520
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Additional Margins• 68 additional margins were excised in 51 patients after
intraoperative specimen verification
• 15 of the 68 additional margins showed carcinoma• 10 of the 15 (67%) showed DCIS
• 30 (59%) patients did not require re-excision; 21 (41%) had positive margins.
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Additional Margins• 3 of the 68 (14%) additional margins excised required
another re-excision of the same margin
• 12 of the 21 (57%) patients requiring re-excision were due to inadequate anterior or posterior margins
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Conclusions• Intraoperative digital mammography is an excellent
addition to a surgeon’s armamentarium, with a decrease in operative time.
• Additional margins can be removed intraoperatively based on immediate imaging.
• Reduced secondary re-excision rates in breast cancer patients with surgical excision and wire localization
• Limited imaging for the anterior and posterior margins
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Possible Improvements• Faxitron Bioptics Wedge
• Orthogonal views
• New techniques are needed to visualize the anterior and posterior margins to further reduce re-excision rates