BACKGROUND: In the United States, about 50% to 66% of women undergoing breast conservation surgery for cancer undergo subsequent mastectomy for positive margins on initial lumpectomy. This is despite the fact that screening mammography has resulted in a decrease in the size of newly diagnosed breast cancer to <2 cm. METHODS: A retrospective review of 128 patients who underwent breast conservation surgery for early breast cancer was performed using intraoperative 2-dimensional Faxitron high-resolution specimen mammography without specimen compression as the only margin assessment technique. Of these, 29 patients had histories of lumpectomy with positive margins. RESULTS: A total of 131 procedures were performed. Margins were histologically clear at initial breast conservation surgery in 84.3% of patients who underwent primary lumpectomy. Subsequent reexcision for positive margins was required in 14.7% of patients. Two-dimensional Faxitron mammographically guided intraoperative reexcision cleared the margins in 95.8% of patients (23 of 24) who would have otherwise required subsequent reexcision. CONCLUSIONS: Intraoperative 2-dimensional Faxitron high-resolution specimen mammography can decrease rates of margin positivity and has the potential to diminish the number of subsequent undesired mastectomies for positive margins.
- Failed breast conservation
- Intraoperative margin assessment
- Reexcision rates
- Specimen mammography
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