Evaluation of Surgical Re-excision Rates with Bioptics Biovision Imaging

Sarah De Los Santos BA, Anita Sambamurty BS,

Anita P. McSwain MD MPH FACS, Christine B. Teal MD FACS

Purpose

To assess the efficacy of examining specimen margins with Bioptics Biovision imaging to potentially reduce re-excisions for patients undergoing breast

surgical excision by wire localization.

Introduction• The diagnosis of breast cancer is generally made by

ultrasound or sterotactic guided core needle biopsy.

• When a patient is not amenable to needle biopsy or when pathology shows an abnormal lesion that is not palpable, surgical excision with wire localization is necessary.

• Wire localization is performed in the radiology suite by ultrasound or mammographic guidance.

Surgical Excision

Faxitron Bioptics Biovision

Intaoperative Specimen Verification

• Bioptics Biovision versus Traditional Analog Xray

• Immediate intraoperative digital imaging

• Higher Quality Images

• Portable

• Decreased operating time

Bioptics BioVision Imaging vs Analog XRay

• 35 patients undergoing excisional biopsies by wire localization

• Bioptics BioVision required less time for specimen radiography

Imaging Modality Range of Time Average Time

Bioptics Biovision 1.3 – 4.0 min 1.9 min

Analogy XRay 12.6 – 19.3 min 15.8 min

Presented at the 13th Annual Meeting of the American Association Society of Breast Surgeons

Factors Associated with Re-Excision• 351 patients with Early Stage Breast Cancer that were

treated with breast conservation surgery

• 118 patients required RE for close surgical margins• DCIS was present in 77 (65%) of the involved margins

• 211 patients had surgical excision requiring wire localization• 76 patients (36%) of the 211 required re-excision due to close

margins• 39 of the 140 patients (28%) who had palpable tumors required a

secondary re-excision

Printed in The American Surgeon, Vol 76, March 2010

Methods

MethodsSuperior

Inferior

MedialLateral

Does NOT assessAnteriorPosterior

Methods

• Retrospective Chart Review of 127 Breast Excisions by Wire Localization

Variables studiedRe-excision Rates & Pre-operative Diagnosis

• Breast Cancer• Other: Atypia, Papilloma, not amenable to needle biopsy

Positive Margins

• Anterior and Posterior Margins• All other Margins

Additional Margins taken during surgery

• Positive Margins with cancer• Additional Re-excision

Results: Re-Excision Rates

All Cases Cancer Diagnoses Atypia, Papillomas or Unknown Diagnosis

0

20

40

60

80

100

120

140

Nu

mb

er o

f P

atie

nts

1037

48

Total: 127

Total: 109

Total: 18

38% 34% 55%

Our previous Re-excision rate – 36%

Positive Margins requiring Re-excision

Anterior Posterior Anterior and Posterior

Other Margins0

5

10

15

20

25

Nu

mb

er o

f P

atie

nts

110 17

Sup = 4

28 of the 48 (58%) patients requiring re-excision had inadequate anterior or posterior margins

21% 35% 2% 42%

Inf = 4

Med = 7

Lat = 520

Additional Margins• 68 additional margins were excised in 51 patients after

intraoperative specimen verification

• 15 of the 68 additional margins showed carcinoma• 10 of the 15 (67%) showed DCIS

• 30 (59%) patients did not require re-excision; 21 (41%) had positive margins.

Additional Margins• 3 of the 68 (14%) additional margins excised required

another re-excision of the same margin

• 12 of the 21 (57%) patients requiring re-excision were due to inadequate anterior or posterior margins

Conclusions• Intraoperative digital mammography is an excellent

addition to a surgeon’s armamentarium, with a decrease in operative time.

• Additional margins can be removed intraoperatively based on immediate imaging.

• Reduced secondary re-excision rates in breast cancer patients with surgical excision and wire localization

• Limited imaging for the anterior and posterior margins

Possible Improvements• Faxitron Bioptics Wedge

• Orthogonal views

• New techniques are needed to visualize the anterior and posterior margins to further reduce re-excision rates