vv 009 Citation: Mylvaganam S, Tafazal H, Caddick V, Madahar P (2018) Breast conserving surgery and intra-operative specimen radiography: Margin assessment by the surgeon or the radiologist? Int J Radiol Radiat Oncol 4(1): 009-013. DOI: http://dx.doi.org/10.17352/ijrro.000028 https://dx.doi.org/10.17352/ijrro DOI: ISSN: 2640-7566 CLINICA l GROUP Research Article Breast conserving surgery and intra- operative specimen radiography: Margin assessment by the surgeon or the radiologist? Senthurun Mylvaganam 1 *, Habib Tafazal 1 , Virginia Caddick 2 and Priya Madahar 1 1 Department of Breast Surgery, Royal Wolverhampton Hospitals NHS Trust, New Cross Hospital, Wolverhampton, UK 2 Department of Plastic Surgery, Queen Elizabeth Hospital, Birmingham, UK Received: 12 June, 2018 Accepted: 29 June, 2018 Published: 02 July, 2018 *Corresponding author: Mr Senthurun Mylvaganam, Consultant Oncoplastic Breast Surgeon, Department of Breast Surgery, Royal Wolverhampton Hospitals NHS Trust, New Cross Hospital, Wolverhampton, WV10 0QP, UK,Tel: (+44) 7779303447; E-mail: Keywords: Breast disease; Margin assessment; Intra- operative specimen radiography https://www.peertechz.com Introduction Breast conserving surgery (BCS) is a safe, effective and widespread treatment for the management of early stage breast cancers [1-3]. The purpose of BCS is to remove the cancer with an effective margin [4], whilst maintaining the cosmetic appearance of the breast [5,6]. For control of local recurrence, excision with clear margins has established importance [7]. Local recurrence has also been shown to impact on overall survival with the Early Breast Cancer Triallists’ Collaborative Group concluding that avoiding four local recurrences prevents one breast cancer related death when other causes of death are excluded [8,9]. The UK National Health Service (NHS) breast screening programme, by detecting cancers early in their natural history, often identify clinically impalpable lesions [10-11]. This presents unique challenges to the surgeon particularly in intra-operative assessment of adequacy of excision. Radiologically positioned wire guidance and ultrasound marking are established interventions to aid the surgeon in localizing clinically impalpable lesions [12-16]. Different modalities have been employed to subsequently assess intra-operative adequacy of excision margins. Specimen mammography is one assessment modality, which has been found to be useful but not always reliable for detecting margin involvement [17-19]. The literature shows some variation with negative predictive values as low as 32% and sensitivity up to 62% for radiologically detecting tumour at the margins [20]. A specimen X-ray, which correctly interpreted as identifying a clear or close/involved margin intra-operatively allows the Abstract In the United Kingdom since the late 1990s there has been both a shortage of and falling level in recruitment of breast radiologists/radiographers. Specimen radiography is a widely used intra-operative adjunct to aid margin assessment in patients undergoing wide local excision for early stage breast cancer. Aim: This study looks to determine accuracy and congruence of radiological intra-operative margin assessment by surgeon and consultant radiographer against the gold standard of histological assessment. Methods: Prospective assessment of specimen margins for all wide local excisions performed between June 2015 and June 2017 by a single breast surgeon in the UK. Specimen radiographs were independently assessed by a consultant radiographer and surgeon for adequacy of margins and compared to histological assessment. Results: Both surgeon and consultant radiographer had an equal sensitivity of 33%, and specificity of 63% versus 73%. Negative predictive values were 89.2 (surgeon) vs 90.5 (radiographer). There was fair agreement between surgeon and radiographer (kappa= 0.252). Discussion: The accuracy of margin assessment by the radiologist in this study is similar to current literature. There is agreement between surgeon and radiographer and a high negative predictive value observed for both in x-ray interpretation suggesting equivalence of assessment and high confidence in evaluating negative margins. With the current UK trend of increasing radiology specific breast disease workload and recruitment deficit, a surgeon margin assessment only of the specimen x-ray may more optimally utilise radiology time without compromising re-operation rates.