Surgical Margins Status Assessment After Breast Conserving Surgery: Is There a Difference Between Surgeon and Radiologist Evaluation

Background: The aim of this study is to evaluate the accuracy of intra-operativespecimen mammography (ISM) in surgical margins status assessment and highlightthe concordance between the interpretations of the surgeon and the radiologist.Methods: Our cross-sectional study included ۱۳۰ patients with early breastcancer, surgically treated between October ۲۰۱۳ and September ۲۰۱۷ in themultidisciplinary breast center of the A.O.U. City of Health and Science (which isa complex of several hospitals) in Turin, Italy. All recruited patients underwentbreast conservative surgery. Surgical margins were evaluated intraoperatively,using intra-operative specimen mammography. A standard compression intraoperativespecimen mammography was obtained by the surgeon using thededicated radiological equipment (Faxitron®, BioVision). After the surgeon’sevaluation of the margins, Faxitron images were sent to PACS. All ISMs imageswere analyzed by the same specialized radiologist in remote access to confirm thesurgeon evaluation. We used kappa formula to report concordance.Results: The discordance rate of positive readings between the surgeon and theradiologist was ۵.۳% while that of negative readings was ۶.۹%. The concordance ratebetween radiologist and pathologist assessments was ۱۰۰%. Intra-operative specimenmammography specificity was ۹۴% (۹۵% CI: ۸۸–۹۷), and sensitivity was ۴۷% (۹۵%CI: ۳۸–۵۶), with PPV found to be ۵۳% (۹۵% CI: ۹۵% ۴۴-۶۲) and NPV determined tobe ۹۲% (۹۵% CI: ۸۶–۹۶), when the assessment was made by the surgeon.Conclusion: Intra-operative specimen mammography is a helpful tool toidentify infiltrated margins and to reduce the rate of secondary surgeries byrecommending targeted re-excisions of corresponding orientations in order toobtain a final negative margin status. In our experience, not only radiologists butalso surgeons could correctly read Faxitron® intra-operative specimenmammography.