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BIopoptics biovision
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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