Abstract
Objective
To evaluate factors contributing to positive surgical margins associated with reflector
guidance for patients undergoing breast conserving therapy for malignancy.
Materials and Methods
A retrospective IRB-approved review of our institutional database was performed for
malignant breast lesions preoperatively localized from January 1, 2018 to December
31, 2020. The following data was recorded using electronic medical records: lesion
type and grade, lesion location, reflector and wire placement modality, use of intraoperative
ultrasound, margin status, patient age, family history, BMI, and final pathology.
Statistical analysis was performed with univariate summary statistics and logistic
regression. P < .05 was significant.
Results
A total of 606 image-guided pre-surgical localizations were performed for lumpectomies
of breast malignancies. A total of 352 of 606 (58%) wire localizations and 254 of
606 (42%) SCOUT reflector localizations were performed. Sixty out of 352 (17%) of
wire-localized patients had positive surgical margins, whereas forty-eight out of
254 (19%) of reflector-localized patients had positive surgical margins. (OR = 1.12,
P value: .59). For reflector guided cases, the use of intraoperative ultrasound (IOUS)
was associated with decreased positive margin status (OR = 0 .28, 95% CI = [0.14,
0.58]) while in situ disease was associated with increased positive margin status
(OR = 1.99, 95% CI = [1.05, 3.75]). No association between modality used for localization
(mammography vs. ultrasound) and positive margin status was observed (OR = 0.63, 95%
CI = [0.33, 1.19]). No association between positive margins and age, family history,
tumor location and BMI was observed.
Conclusion
For reflector guided surgeries, the use of IOUS was associated with decreased positive
margins, by contrast the presence of ductal carcinoma in situ was associated with
increased positive margins. There was no statistically significant difference in surgical
outcomes for reflector-guided localization compared to wire localizations of the breast.
Keywords
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Article info
Publication history
Published online: July 12, 2021
Accepted:
July 6,
2021
Received in revised form:
July 5,
2021
Received:
June 4,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
