Layfield, D. M, May, D. J., Cutress, R. I., Richardson, C., Agrawal, A., Wise, M and Yiangou, C.
The effect of introducing an in-theatre intra-operative specimen radiography (IOSR) system on the management of palpable breast cancer within a single unit
The Breast (doi:10.1016/j.breast.2011.10.010). (PMID:22119488).
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Introduction: Intra-operative specimen radiography (IOSR) is used to screen specimens during breastconserving
surgery and attempt to identify incompletely excised lesions. Universal use of IOSR during
surgery for impalpable breast cancer is advocated by current guidelines. This study evaluates the role of
IOSR during breast-conserving surgery for palpable breast cancer.
Methods: Two cohorts of patients who underwent wide local excision for palpable breast cancer were
identified. Retrospective analysis of histological margins, intra-operative cavity shaves, secondary reexcision
rates and specimen weight was completed comparing performance prior to the introduction
of IOSR (October 2003eApril 2005) with that since its introduction (April 2006eOctober 2007).
Results: 224 Patients were included, 111 in the pre-IOSR cohort (PF) and 113 in the IOSR cohort (F). Patient
demographics, tumour size and histology were comparable. No difference in margin involvement prior to
intra-operative cavity shaving was noted, PFe26, Fe31 (p ¼ 0.60). Intra-operative cavity shaves were
carried out more frequently in the IOSR group, PFe9, Fe32 (p ¼ 0.001). When compared with histological
findings, IOSR identified margin compromise with sensitivity¼ 58.1%, specificity ¼ 80.8%, positivepredictive
value ¼ 56.25% and negative predictive value ¼ 81.9%. Re-operation ratewas similar between the
2 groups, PFe26, Fe31 (p ¼ 0.65). Significantly less tissue was excised following use of IOSR; PFe110 g,
Fe70 g (p ¼ 0.001).
Conclusion: Introduction of IOSR significantly reduced specimen weights without increasing re-excision
rates. As volume of breast tissue removed is the most significant determinant of cosmetic outcome
following breast-conserving surgery, the use of IOSR should be advocated in the surgical management of
palpable breast cancer.
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