Quality Assurance of Breast Surgery of Non-Palpable Breast Lesions with Microcalcifications by Biplanar Breast Specimen Radiography

摘要

Purpose: Intraoperative breast specimen radiography is frequently performed in one plane only. This could be due to technical difficulties associated with biplanar specimen radiography. We have built a breast specimen device, that compensates for these methodical problems. Using this device it was examined, to whitch extend biplanar specimen radiography can optimise intraoperative assessment of the margins of resected impalpable breast lesions with microcalcifications. Materials and Methods: Using a special device for specimen radiography without compression.and with minimising artefacts induced by beam divergency biplanar compression-free radiography was performed in 44 breast specimen with microcalcifications. The minimal distance of the microcalcifications from the margin of the specimen was measured in two perpendicular planes. Results: Minimal distances of microcalcifications from the margin of the specimen showed clear differences in the two perpendicular planes (mean = 4,1 mm, maximum=22 mm). In 16 of the 44 specimen the differences of the minimal distances were 5 mm and more, in 5 specimen 10 mm and more. Considering the plane of the specimen with the greater distance of the microcalcifications to the margin only, the diagnoses regarding micro-calcification-free margins of 5 mm (10 mm) were false negative in 51,6 % (29,3 %). Conclusion: For intraoperative assessment of the margins of resected impalpable breast lesions with microcalcifications biplanar specimen radiography is essential. In biplanar specimen radiography artefacts induced by beam divergency and artefact caused by compression have to be considered and can be avoided by using a specimen device for biplanar specimen radiography. Biplanar specimen radiography can reduce false-negative results in the assesment of the microcalcification-free margins and the necessity of further explorative surgery.