Role of specimen radiography in patients treated with skin-sparing mastectomy for ductal carcinoma in situ of the breast

Background: Specimen radiography is an important part of breast conservatio n surgery for ductal carcinoma in situ (DCIS). The objective of this study was to determine whether mastectomy specimen radiography could help in obta ining negative resection margins in patients with DCIS undergoing skin-spar ing mastectomy (SSM) with immediate breast reconstruction (IBR), Methods: Of 95 patients treated at our institution with SSM and IBR for DCI S, 35 had specimen radiogaphy. The mastectomy specimen was first examined g rossly and then inked, serially sectioned, and sent for radiographic assess ment. Tissue slices containing calcifications were identified for pathologi c evaluation. Additional tissue was excised if tumor was found near the ink ed margins or if calcifications were found near the radiographic margins. Results: Of the 35 patients who had specimen radiography, the radiographic margins were free of calcifications in 30 patients (86%); of these patients , the margins on the final histologic examination were free of tumor in 27 and within 1 mm in 3. The other five patients (14%) had calcifications clos e to the radiographic margin; four underwent an intraoperative re-excision, but the margin for one of those four patients was still positive on final histologic examination. Margins were found to be negative by both mastectom y specimen radiography and histology in 77% of the patients. Of the 95 pati ents with DCIS, three patients (3%), none of whom had specimen radiography, developed local recurrences. One of these was successfully re-treated, one died as a result of synchronous distant metastases, and one was lost to fo llow-up. At a median follow-up time of 3.7 years, 93 patients (98%) were al ive and free of disease. Conclusions: Intraoperative radiography of mastectomy specimens may be usef ul for assessing margin status and for identifying the location of microcal cifications within tissue slices.