The reliability of specimen X-rays in assessing surgical margins in breast conserving surgery
Association of Breast Surgery ePoster Library. Dunlop H. 05/15/17; 166218; P155
Ms. Hannah Dunlop
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Abstract
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Introduction:
It has been shown that the attainment of a clear excision margin is an important predictor of treatment success and the risk of local recurrence. Specimen X-ray is routinely used to confirm the excision of impalpable lesions, although its reliability to predict adequate excision margins is controversial. Therefore, we retrospectively reviewed specimen X-ray images and corresponding pathological margins.
Methods:
Data comprised of consecutive patients who underwent wide local excision, for DCIS or invasive carcinoma between 2013 and 2014, where the excised specimen was X-rayed. This yielded a total of 432 margins (4 per patient); each margin was measured on the PACS system, and was compared to the pathological margin. In both radiology and pathology, a margin of 1mm or less was considered “involved”.
Results:
Of the 432 margins studied, 414 margins looked clear on the specimen X-ray and 19 looked involved. All those with involved margins on the specimen X-ray had immediate further excision. In fact, of those 19 that looked involved, only 12 were involved pathologically and 7 were clear pathologically.
Of the 414 margins that looked clear on the specimen X-ray, 62 (14.9%) were involved pathologically and 352 were clear pathologically.
Sensitivity (true positive rate) = 12/12+62 = 16%
Specificity (true negative rate) = 351/351+7 = 98%
Conclusion:
The specificity of specimen X-ray margins is high (98%), and the sensitivity is low. These results suggest that specimen X-rays are a reliable way to assess margins and decide about immediate re-excision in theatre.
It has been shown that the attainment of a clear excision margin is an important predictor of treatment success and the risk of local recurrence. Specimen X-ray is routinely used to confirm the excision of impalpable lesions, although its reliability to predict adequate excision margins is controversial. Therefore, we retrospectively reviewed specimen X-ray images and corresponding pathological margins.
Methods:
Data comprised of consecutive patients who underwent wide local excision, for DCIS or invasive carcinoma between 2013 and 2014, where the excised specimen was X-rayed. This yielded a total of 432 margins (4 per patient); each margin was measured on the PACS system, and was compared to the pathological margin. In both radiology and pathology, a margin of 1mm or less was considered “involved”.
Results:
Of the 432 margins studied, 414 margins looked clear on the specimen X-ray and 19 looked involved. All those with involved margins on the specimen X-ray had immediate further excision. In fact, of those 19 that looked involved, only 12 were involved pathologically and 7 were clear pathologically.
Of the 414 margins that looked clear on the specimen X-ray, 62 (14.9%) were involved pathologically and 352 were clear pathologically.
Sensitivity (true positive rate) = 12/12+62 = 16%
Specificity (true negative rate) = 351/351+7 = 98%
Conclusion:
The specificity of specimen X-ray margins is high (98%), and the sensitivity is low. These results suggest that specimen X-rays are a reliable way to assess margins and decide about immediate re-excision in theatre.
Introduction:
It has been shown that the attainment of a clear excision margin is an important predictor of treatment success and the risk of local recurrence. Specimen X-ray is routinely used to confirm the excision of impalpable lesions, although its reliability to predict adequate excision margins is controversial. Therefore, we retrospectively reviewed specimen X-ray images and corresponding pathological margins.
Methods:
Data comprised of consecutive patients who underwent wide local excision, for DCIS or invasive carcinoma between 2013 and 2014, where the excised specimen was X-rayed. This yielded a total of 432 margins (4 per patient); each margin was measured on the PACS system, and was compared to the pathological margin. In both radiology and pathology, a margin of 1mm or less was considered “involved”.
Results:
Of the 432 margins studied, 414 margins looked clear on the specimen X-ray and 19 looked involved. All those with involved margins on the specimen X-ray had immediate further excision. In fact, of those 19 that looked involved, only 12 were involved pathologically and 7 were clear pathologically.
Of the 414 margins that looked clear on the specimen X-ray, 62 (14.9%) were involved pathologically and 352 were clear pathologically.
Sensitivity (true positive rate) = 12/12+62 = 16%
Specificity (true negative rate) = 351/351+7 = 98%
Conclusion:
The specificity of specimen X-ray margins is high (98%), and the sensitivity is low. These results suggest that specimen X-rays are a reliable way to assess margins and decide about immediate re-excision in theatre.
It has been shown that the attainment of a clear excision margin is an important predictor of treatment success and the risk of local recurrence. Specimen X-ray is routinely used to confirm the excision of impalpable lesions, although its reliability to predict adequate excision margins is controversial. Therefore, we retrospectively reviewed specimen X-ray images and corresponding pathological margins.
Methods:
Data comprised of consecutive patients who underwent wide local excision, for DCIS or invasive carcinoma between 2013 and 2014, where the excised specimen was X-rayed. This yielded a total of 432 margins (4 per patient); each margin was measured on the PACS system, and was compared to the pathological margin. In both radiology and pathology, a margin of 1mm or less was considered “involved”.
Results:
Of the 432 margins studied, 414 margins looked clear on the specimen X-ray and 19 looked involved. All those with involved margins on the specimen X-ray had immediate further excision. In fact, of those 19 that looked involved, only 12 were involved pathologically and 7 were clear pathologically.
Of the 414 margins that looked clear on the specimen X-ray, 62 (14.9%) were involved pathologically and 352 were clear pathologically.
Sensitivity (true positive rate) = 12/12+62 = 16%
Specificity (true negative rate) = 351/351+7 = 98%
Conclusion:
The specificity of specimen X-ray margins is high (98%), and the sensitivity is low. These results suggest that specimen X-rays are a reliable way to assess margins and decide about immediate re-excision in theatre.
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