ABS ePoster Library

P084
Topic: Margins

Introduction: Breast lumpectomy specimens are routinely orientated intra-operatively usingmarking stitches,toaid the pathologists in determining specimen orientation post-operatively. Re-excision is recommended for involvedmargins,therefore correlation in specimen orientation is crucial.Weconducteda feasibility study to assessthe pathological accuracy ofintra-operativestitch orientation. Methods :After Trust approval (service evaluation ID=267), prospective data was collected from patients undergoing wide local excision for breast cancer. Lumpectomy specimen dimensions (mm) and weight (g) were recorded intra-operatively (by the surgeon) and post operatively (by the pathologists). Intra-operatively, the surgeon placed a random undyed stitch in the lumpectomy specimen and its margin plane orientation (anterior, posterior, inferior, superior, medial, lateral) and clock face orientation was compared to post-operative, pathology orientation. Results:All specimens (n=16) were orientated intra-operatively with long lateral/short superior marking stitches, n=5 also had an anterior loop stitch sited. An additional undyed stitch was placed into all specimens. Comparing pathologist and surgeon orientation, we found 25% (4/12) discordance in the additional stitch using margin plane orientation and 87.5% discordance using the clock face method. Mean pathology tissue measurements of width, length and weight was underestimated in comparison with intra-operative surgeon measurements by 5%, 17% and 6%, respectively. Whilst mean height was overestimated by 29%. Conclusions:Intra-operative specimen marking using stitches and tissue measurements showed discordance with post-operative pathology reporting. Other published studies have reported similar discordance. As focal re-excision is recommended for positive margins, techniques should be sought to optimise specimen orientation (e.g. intra-operative specimen inking).