Re-excision rates in breast conserving surgery after neoadjuvant chemotherapy (NACT) with and without the use of a radiopaque tissue transfer and X-ray system

Background:

Published re-excision rates after breast conserving surgery for invasive breast cancer vary between 20 and 50%. In patients after NACT even higher re-excision rates may occur. Specimen radiography is reducing re-excision rates, however, defining involved margins is often difficult using standard approaches. Devices allowing an exact topographic localization of the lesion in the resected tissue could reduce re-excision rates by intraoperative detection of involved margins.

Methods:

80 patients with invasive breast cancer receiving breast conserving surgery after NACT and an indication for wire marking by mammography were included. All tumors were marked with titanium clips prior to chemotherapy. In 40 patients specimen radiography was performed in a standard approach (control group), in 40 patients a tissue transfer and X-ray system based on a non-radiopaque board with radiopaque topographic markers and a stand for cranio-caudal X-rays was used (study group). A univariate analysis was carried out to evaluate the association between the use of the radiopaque tissue transfer system and the re-excision rate using a logistic regression model.

Results:

19/80 patients (23.75%) required re-excision because of involved margins; among those patients, 14/40 (35%) were in the control group and 5/40 (12.5%) in the study group. The association between the use of the radiopaque tissue transfer system and the lower re-excision rate was statistically significant (p = 0.023).

Conclusion:

Our analysis provides a rationale for the use of a radiopaque tissue transfer system for specimen radiography in breast conserving surgery after NACT for invasive breast cancer in order to reduce re-excision rates.