Heba A Amer1, Florian Schmitzberger2, Barbara Ingold-Heppner3, Julia Kussmaul4, Manal F El Tohamy5, Hazim I Tantawy5, B Hamm6, M Makowski7, Eva M Fallenberg8. 1. Dept of Radiology, Zagazig University Hospitals, Zagazig, Egypt; Clinic of Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. 2. Clinic of Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: Florian.schmitzberger@charite.de. 3. Institute of Pathology, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: Barbara.ingold-heppner@charite.de. 4. Clinic of Radiology, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: julia.kussmaul@charite.de. 5. Dept of Radiology, Zagazig University Hospitals, Zagazig, Egypt. 6. Clinic of Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: bernd.hamm@charite.de. 7. Clinic of Gynacolgy and Breast Center, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: marcus.makowski@charite.de. 8. Clinic of Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: eva.fallenberg@charite.de.
Abstract
OBJECTIVES: To evaluate the reliability of tumor margin assessment in specimen radiography (SR) using digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in comparison to postoperative histopathology margin status as the gold standard. METHODS: After ethics committee approval, 102 consecutive patients who underwent breast conservative surgery for nonpalpable proven breast cancer were prospectively included. All patients underwent ultrasound/mammography-guided wire localization of their lesions. After excision, each specimen was marked for orientation and imaged using FFDM and DBT. Two blinded radiologists (R1, R2) independently analyzed images acquired with both modalities. Readers identified in which direction the lesion was closest to the specimen margin and to measure the margin width. Their findings were compared with the final histopathological analysis. True positive margin status was defined as a margin measuring <1mm for invasive cancer and 5mm for ductal carcinoma in situ (DCIS) at imaging and pathology. RESULTS: For FFDM, correct margin direction was identified in 45 cases (44%) by R1 and in 37 cases (36%) by R2. For DBT, 69 cases (68%) were correctly identified by R1 and 70 cases (69%) by R2. Overall accuracy was 40% for FFDM and 69% for DBT; the difference was statistically significant (p<0.0001). Sensitivity in terms of correct assessment of margin status was significantly better for DBT than FFDM (77% versus 62%). CONCLUSION: SR using DBT is significantly superior to FFDM regarding identification of the closest margin and sensitivity in assessment of margin status.
OBJECTIVES: To evaluate the reliability of tumor margin assessment in specimen radiography (SR) using digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in comparison to postoperative histopathology margin status as the gold standard. METHODS: After ethics committee approval, 102 consecutive patients who underwent breast conservative surgery for nonpalpable proven breast cancer were prospectively included. All patients underwent ultrasound/mammography-guided wire localization of their lesions. After excision, each specimen was marked for orientation and imaged using FFDM and DBT. Two blinded radiologists (R1, R2) independently analyzed images acquired with both modalities. Readers identified in which direction the lesion was closest to the specimen margin and to measure the margin width. Their findings were compared with the final histopathological analysis. True positive margin status was defined as a margin measuring <1mm for invasive cancer and 5mm for ductal carcinoma in situ (DCIS) at imaging and pathology. RESULTS: For FFDM, correct margin direction was identified in 45 cases (44%) by R1 and in 37 cases (36%) by R2. For DBT, 69 cases (68%) were correctly identified by R1 and 70 cases (69%) by R2. Overall accuracy was 40% for FFDM and 69% for DBT; the difference was statistically significant (p<0.0001). Sensitivity in terms of correct assessment of margin status was significantly better for DBT than FFDM (77% versus 62%). CONCLUSION: SR using DBT is significantly superior to FFDM regarding identification of the closest margin and sensitivity in assessment of margin status.
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