Sentinel Lymph Node Biopsy as a Tool for the Staging of Ductal Carcinoma In Situ in Patients with Breast Carcinoma

Purpose. Ductal carcinoma in situ (DCIS) of the breast is defined as stage 0 disease, but its diagnosis is subject to sampling errors. This study was conducted to assess the usefulness of sentinel lymph node biopsy (SLNB) for furnishing indirect evidence of the invasion of tumors diagnosed as DCIS. Methods. A total of 201 SLNB procedures performed using a peritumoral tracer, being either dye alone or dye plus ^99mTc-labeled colloidal albumin, were reviewed. The cases of DCIS were selected for analysis, and the results were compared with published data. Results. Among ten cases of DCIS studied by SLNB, only one had micrometastatic nodal involvement, which was revealed by cytokeratin immunostaining, and was limited to the sentinel node. This was a large intermediate-grade micropapillary/cribriform-type DCIS. Conclusion. These findings indicate that while SLNB may be a valuable tool for the staging of tumors diagnosed as DCIS, it should not be performed in all cases, but probably restricted to large, high-grade, or comedo-type intraductal carcinomas. Received: February 5, 2001 / Accepted: September 11, 2001     

Sentinel Node Biopsy in Ductal Carcinoma In Situ Patients

Background: Sentinel lymph node (SLN) mapping is an effective and accurate method of evaluating the regional lymph nodes in breast cancer patients. The SLN is the first node that receives lymphatic drainage from the primary tumor. Patients with micrometastatic disease, previously undetected by routine hematoxylin and eosin (H&E) stains, are now being detected with the new technology of SLN biopsy, followed by a more detailed examination of the SLN that includes serial sectioning and cytokeratin immunohistochemical (CK IHC) staining of the nodes.Methods: At Moffitt Cancer Center, 87 patients with newly diagnosed pure ductal carcinoma in situ (DCIS) lesions were evaluated by using CK IHC staining of the SLN. Patients with any focus of microinvasive disease, detected on diagnostic breast biopsy by routine H&E, were excluded from this study. DCIS patients, with biopsy-proven in situ tumor by routine H&E stains, underwent intraoperative lymphatic mapping, using a combination of vital blue dye and technetium-labeled sulfur colloid. The excised SLNs were examined grossly, by imprint cytology, by standard H&E histology, and by IHC stains for CK. All SLNs that had only CK-positive cells were subsequently confirmed malignant by a more detailed histological examination of the nodes.Results: CK IHC staining was performed on 177 SLNs in 87 DCIS breast cancer patients. Five of the 87 DCIS patients (6%) had positive SLNs. Three of these patients were only CK positive and two were both H&E and CK positive. Therefore, routine H&E staining missed microinvasive disease in three of five DCIS patients with positive SLNs. In addition, DCIS patients with occult micrometastatic disease to the SLN underwent a complete axillary lymph node dissection, and the SLNs were the only nodes found to have metastatic disease. Of interest, four of the five nodepositive patients had comedo carcinoma associated with the DCIS lesion, and one patient had a large 9.5-cm low grade cribriform and micropapillary type of DCIS.Conclusions: This study confirms that lymphatic mapping in breast cancer patients with DCIS lesions is a technically feasible and a highly accurate method of staging patients with undetected micrometastatic disease to the regional lymphatic basin. This procedure can be performed with minimal morbidity, because only one or two SLNs, which are at highest risk for containing metastatic disease, are removed. This allows the pathologist to examine the one or two lymph nodes with greater detail by using serial sectioning and CK IHC staining of the SLNs. Because most patients with DCIS lesions detected by routine H&E stains do not have regional lymph node metastases, these patients can safely avoid the complications associated with a complete axillary lymph node dissection and systemic chemotherapy. However, DCIS patients with occult micrometastases of the regional lymphatic basin can be staged with higher accuracy and treated in a more selective fashion.Presented at the 52nd Annual Meeting of Society of Surgical Oncology, Orlando, Florida, March 4–7, 1999.     

Large-Gauge Core Needle Biopsy of the Breast

Abstract: Large-gauge core needle biopsy (LGCNB) of the breast is gaining acceptance as a viable alternative to surgical excision. The procedure can be performed efficiently using ultrasound or stereotactic guidance. We report our experience with 137 LGCNB performed over a 40-month period. One hundred thirty-seven lesions in 125 patients were subjected to LGCNB. Fifty-nine procedures were performed using stereotactic guidance and 78 using ultrasound guidance. Stereotactic procedures utilized a prone table and ultrasound procedures used a freehand technique. All biopsies were performed with a 14-gauge core needle attached to an automated biopsy device. There were 53 malignant and 84 benign diagnoses in this group of 137 LGCNB. Surgical correlation is available in 46 of the 53 malignant cases. There were no false positives, though one lesion was missed at the initial surgical excision but retrieved at reexcision. Of the 84 benign cases, there has been surgical (n = 10) or mammographic follow-up (n = 32) in 42. The mean duration of mammographic follow-up is 13 months (range: 5–36 months). There was one false negative LGCNB. The sensitivity, specificity, positive predictive value, and negative predictive value in this series are 98%, 100%, 100% and 96%, respectively. LGCNB has a high degree of accuracy and is well accepted by patients. There are some persistent difficulties with the technique, such as ensuring compliance with follow-up recommendations among patients with benign results and excluding invasive carcinoma.?     

Recurrent Mastitis after Core Needle Biopsy: Case Report of an Unusual Complication after Core Needle Biopsy of a Phyllodes Tumor

BACKGROUND: In the routine work-up of suspect breast lesions, ultrasound-controlled core needle biopsy (CNB) is the most common tool to acquire tissue for histopathologic analysis in a safe, quick and convenient way. Complications are generally rare. The most common complications are hematoma and infection, each with less than 1 in 1000 cases. CASE REPORT: Here, we present a case of a 48-year-old patient who underwent CNB for several lesions that were assessed as Breast Imaging Report and Data System (BI-RADS) IV in breast ultrasound and mammography. In the past, she had had 2 bilateral breast reduction surgeries and 1 open biopsy of a fibroadenoma. Histology revealed a phyllodes tumor. Following this, mastitis occurred which was resistant to common conservative measurements such as intravenous antibiotics over months. Finally, mastectomy was performed, followed by adequate wound healing. CONCLUSIONS: In the presented case, the prolonged course of breast infection after CNB was not as expected. If this occurs, conservative treatment with antibiotics can be initiated. Possible additional risk factors such as diabetes mellitus, steroid therapy, or immunosuppression should be identified. However, in case of missing recovery, wide surgical excision is recommended.     

超声引导空芯针穿刺活检诊断乳腺癌激素受体状态的价值

目的探讨超声引导空芯针穿刺活检(ultrasound-guided core needle biopsy,US-CNB)检测乳腺癌激素受体状态的准确性。方法回顾性分析2016年9月~2019年4月127例未经过新辅助治疗的131个乳腺癌病灶。US-CNB后7~46 d行乳腺癌手术。对比US-CNB和手术切除组织的病理结果,包括雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)。结果US-CNB均顺利完成。US-CNB标本中ER阳性、阴性病灶分别为121个(121/131,92.4%)和10个(10/131,7.6%),术后标本中分别为120个(120/131,91.6%)和11个(11/131,8.4%)(McNemar检验P=1.000),两者诊断一致率为99.2%(130/131)(κ=0.948,P=0.000)。US-CNB标本中PR阳性、阴性病灶分别为106个(80.9%,106/131)和25个(19.1%,25/131),术后标本中分别为106个(80.9%,106/131)和25个(19.1%,25/131)(McNemar检验P=1.000),两者诊断一致率为95.4%(125/131)(κ=0.852,P=0.000)。US-CNB与手术标本ER、PR表达性质均无统计学差异(McNemar检验P=1.000)。在表达比例方面,US-CNB与手术标本ER阳性细胞所占比例差异无统计学意义[中位数90%(70%~90%)vs.90%(80%~90%),Wilcoxon检验,Z=-1.804,P=0.071]。US-CNB与手术标本PR阳性细胞所占比例差异无统计学意义[中位数60%(5%~90%)vs.60%(5%~90%),Wilcoxon检验,Z=-0.592,P=0.554]。US-CNB与手术标本ER、PR表达强弱差异无统计学意义(Wilcoxon检验,Z=-0.786、P=0.432;Z=-1.792,P=0.073)。结论US-CNB可准确评价乳腺癌雌、孕激素受体表达状态,是术前评估乳腺癌激素受体表达的可靠方法。     

Preoperative Profiling of Symptomatic Breast Cancer by Diagnostic Core Biopsy

Background Precise preoperative profiling of breast tumors could facilitate fuller consideration of (neo)adjuvant therapies. Methods Diagnostic core biopsy (DCB) accuracy in profiling the primary tumor was prospectively studied in 95 patients with operable breast cancer. The histological type and grade (hematoxylin and eosin staining) and membrane receptor status (semiquantitative immunohistochemistry for estrogen [ER] and progesterone [PR] receptors, as well as Her-2 antigen expression) were assigned by the DCB before surgery. These measures were then compared with those of the definitive surgical specimen available after operation. Results DCB correctly ascribed tumor type and grade and ER, PR, and Her-2 receptor status in most cases (correlating exactly in 97.5%, 77%, 68%, 71%, and 60%, respectively) with at least moderate concordance (weighted κ, >.41). When miscategorized, DCB consistently tended to upscore the receptor stain intensity compared with the surgical specimen (22%, 19%, and 27% had higher ER, PR, and Her-2 categorical scores, respectively). ER H-scores correlated best in specimens that stained strongly (224.4 ± 3 vs. 215.5 ± 5) and were significantly higher on DCB in those that stained either moderately (195.6 ± 8.2 vs. 156.8 ± 5.1; P < .0001) or weakly (157.1 ± 24.8 vs. 81.4 ± 4; P = .02). DCB accurately identified all tumors with clinically important ER and Her-2 expression. Furthermore, it promoted three patients into the therapeutically significant range of ER (n = 1) or Her-2 (n = 2) expression. ER negativity on DCB (n = 25) indicated a high-grade tumor (88%), although 11 (44%) patients also overexpressed Her-2. Significant Her-2 expression (n = 16) on DCB predicted the tumor as being poorly differentiated (80%) and both ER and PR negative (67%). Conclusions DCB accurately profiles clinically relevant measures of primary tumor cell differentiation. It also reliably categorizes patients with regard to (neo)adjuvant therapy before radical surgery is attempted.     

空芯针活检漏诊乳腺导管原位癌伴浸润的危险因素分析

目的:分析术前空芯针穿刺(CNB)为乳腺导管原位癌(DCIS)病人,术后诊断为DCIS伴浸润的漏诊比例及相关临床病理因素。方法:回顾性分析2009年10月至2012年2月我院乳腺疾病诊治中心采用CNB诊断为DCIS的52例病人,并与术后最终病理作比较,分析CNB穿刺为DCIS病人发生浸润的相关危险因素。结果 :术前CNB穿刺活检为DCIS的病人,术后病理诊断为DCIS伴浸润的漏诊比例为50%;单因素及Logistic多因素回归分析结果显示首发症状为肿块(OR=6.4,95%CI:1.2～35.2,P=0.032)、临床评估肿块直径≥5 cm(OR=13.0,95%CI:1.2～137.9,P=0.033)是DCIS发生浸润的危险因素。结论:术前CNB为DCIS的病人,其开放手术活检病理为DCIS伴浸润的漏诊危险因素为首发症状为肿块、临床评估肿块直径≥5 cm;这些危险因素有待于前瞻性研究的进一步验证。     

乳腺X线摄影、局部数字化处理与立体核心活检对乳腺癌诊断的意义（附122例分析）

目的：评估立体核检在乳腺癌诊断中的意义。方法：1999年3月15日－2000年3月15日,我院外科门诊应用意大利Giotto乳腺诊断系统行高清晰乳腺X线摄影（HI－TECH mammography,HT-M)1888例,对其中符合：（1）临床Meng及乳腺肿块,性质不明：（2）X线片发现肿块;（3）X线片上有多形性、集簇性微小钙化灶;（4）双侧摄片出现局限不对称、高密度区或结构畸形等适应证者,进行数字化局部处理（digital spot image,DSI)与Bard 16G针立体核心活检（stereotactic core needle biopsy,SCNB)122例,占HT－M总数的6．46％。结果：诊断为乳腺癌（包括2例原位导管癌,1例早期导管浸润癌）59例,全部手术证实：良性病变（包括乳腺增生、纤维腺瘤、导管乳头状瘤、囊腺瘤等）63例,其中23例为手术证实,40例随诊中未发现癌变。在乳腺癌中,SCNB真阳性率为89．83％（53／59）,假阴性率为10．17％（6／59）;乳腺良性病变中SCNB无一例假阳性,故SCNB对乳腺良恶性病变的敏感性和特异性分别为89．83％和100％,全部122例SCNB者均无并发症发生。结论：为保证该项诊断技术的准确性,我们的初步经验是：（1）必须有一套包括高清晰成像、快速准确定位和活检的高质量;（2）由一个有高中级外科医师、外科护师（技师）与病理医师组成的专业小组,参与门诊临床检查→HT－M、DIS、SCNB→病理检查→手术→随1 全过程,不断提高操作的娴熟性、准确性,并在综合分析的基础上作出诊断;（3）自动弹射式Bard 16G针适用于大多数病人,但对X线片上的微小病灶采用负压切削式Mammotome针,能将SCNB正确率提高到95％－100％,想念通过克服传统旧观念,将HT－M、DIS与SCNB广泛用于医院门诊与高危人群的普查,能大大改善我国乳腺癌病人治疗的生存率与生活质量。     

Ductal Carcinoma In Situ of the Breast

Ductal carcinoma in situ (DCIS) of the breast is a potentially invasive neoplasm. Risk factors include high estrogen states such as use of oral contraceptive (OC) pills, nulliparity, advanced age at first birth, and also family history and genetic mutations. The incidence of this usually clinically silent condition has risen in the past few decades due to widespread screening and diagnostic mammography, with final diagnosis confirmed by biopsy. At present, treatment options include total or simple mastectomy or lumpectomy with radiation. Adjuvant therapy includes antiestrogens like tamoxifen and human epidermal growth factor receptor 2 (HER2) suppression therapy. With the latest advances in chemotherapy and better understanding on the pathogenesis of the lesion, it is anticipated that more effective modalities of treatment may soon be available.     

Imaging-Guided Core Needle Biopsy of the Breast: Study of Psychological Outcomes

The objective of this study was to evaluate and document pain and psychological distress related to imaging-guided core needle biopsy (CNB) of the breast. This prospective study of 52 consecutive patients undergoing CNB of the breast assessed anxiety, pain, acute stress disorder, and activities of daily living both preprocedure and at 24 hours, 5 days, and 30 days postprocedure. Survey instruments included the State-Trait Anxiety Inventory (STAI), a visual analog pain scale, the SF-36 Physical Functioning Scale, and DSM IV criteria for acute stress disorder. Preprocedure the mean scores for self-reported levels of state and trait anxiety were 47.11 (SD = 13.53) and 37.71 (SD = 11.24), respectively. At 24 hours postprocedure, the mean score for self-reported state anxiety was 38.74 (SD = 17.77), a significant reduction from the preprocedure level reported by patients (p < 0.005). Further reductions in state anxiety levels were reported at 5 and 30 days postprocedure. The mean scores for state anxiety fell within the normal range at 30 days postprocedure (mean 32.75, SD = 10.97). However, at 5 days post-CNB, patients with confirmed malignancies reported significantly more anxiety than patients without malignancies (p = 0.002). This difference was not present at 30 days post-CNB (p = 0.17). Patients reported average pain scores of 2.0 (on a scale of 0-10) during the biopsy. This decreased to 1.3 at 24 hours, 0.3 at 5 days, and 0.2 at 30 days. Reported symptoms of acute stress related to the procedure significantly increased over the period between the 5-day interview and the 30-day interview. One (2%) patient reported avoidance of thoughts about CNB 5 days postprocedure and 5 (12%) patients reported this at 30 days postprocedure (p < 0.05). Patients undergoing CNB reported significant levels of state anxiety which were greatest at the time of biopsy. A significant decrease was observed at 24 hours postprocedure, despite the fact that biopsy results were not available to the patients. Self-reported levels of anxiety for the group, regardless of biopsy results, fell within the normal range by 30 days. Further research and interventions are recommended to address the management of anxiety for patients undergoing CNB.     

Ductal Carcinoma In Situ Arising in a Benign Phyllodes Tumor: Report of a Case

Malignant epithelial change within a phyllodes tumor (PT) is a rare event. To our knowledge, only six cases of ductal carcinoma in situ arising in a PT have been reported in English. We report a case of PT with an intraductal carcinoma component, which grew rapidly to a huge size in 3 months. Histologically, the stromal element showed mild to moderate cellularity with few mitoses and mild nuclear atypia. The epithelial element consisted of irregularly dilated ducts with a phyllodes structure that had moderate to severe epithelial hyperplasia, and foci of cribriform ductal carcinoma in situ with comedo necrosis.     

Lobular Carcinoma In Situ of the Breast

LCIS was first described in 1941 as a distinct pathologic entity by Foote and Stewart who called it a "rare form of mammary carcinoma." It is thought to represent a transitional intra-epithelial, or in situ, stage in the evolution of breast cancer from hyperplastic breast epithelium. With the wide application of mammography, its detection has increased in recent years, being found in approximately 1% of all breast biopsy specimens and 5% of all breast malignancies. Its true incidence is unknown, because the absence of any clinical or radiographic manifestations makes its detection completely arbitrary and random. LCIS has distinct pathologic features characterized by proliferation of bland, homogeneous malignant cells within the terminal duct-lobular apparatus. The lobular architecture and investing basement membrane remain intact with no evidence of invasion into the surrounding stoma. It is assumed to be widely disseminated throughout all breast tissue whenever it is found, having close to 100% incidence of multicentricity and bilaterality. The cells are typically of low histologic and nuclear grade, highly estrogen receptor positive, and have tumor marker characteristics of indolent growth and good prognosis. This is very different from its noninvasive ductal counterpart, DCIS, which is typified by more aggressive cytologic and biologic characteristics. Although LCIS imparts as much as a 12-fold increased risk of subsequent invasive breast carcinoma, its natural history suggests it is more of a marker of risk rather than a true premalignant lesion. Most subsequent malignancies occur more than 15 years after diagnosis, and are ductal rather than lobular. This risk is also equally applied to both breasts, regardless of which breast contains the diagnosed focus. Subsequent invasive breast cancers are typically early with very low mortality, most likely due to the strict mammographic surveillance provided to these women. Although originally treated by mastectomy, most now manage LCIS by careful non-operative observation, in the same way that other risk factors such as family history or atypical hyperplasia are managed. In fact, it has been questioned whether there should be any real distinction between lobular hyperplasia and LCIS. There is no role for excision of biopsy sites of LCIS to obtain clear margins, nor for cytotoxic chemotherapy. However, the NSABP P-1 Prevention Trial strongly suggests that subsequent risk can be significantly reduced by tamoxifen. The only rational surgical treatment, if ablation is judged necessary, would be bilateral mastectomy, which appears far too aggressive in view of its low overall risks. Further investigation should clarify the optimal management of LCIS.     

First Report of a Necrotising Fasciitis of the Breast Following a Core Needle Biopsy

Abstract:  Necrotising fasciitis (NF) is the most aggressive form of soft tissue infection. We report the first case of NF of the breast following a core needle biopsy. Aggressive management including surgical debridement and vacuum therapy allowed wound healing and breast conservation.     

Breast Papillomas in the Era of Percutaneous Needle Biopsy

Background The significance of breast papillomas detected on core needle biopsy (CNB) remains unclear. While those associated with malignancy or atypia are excised, no clear solution exists for benign papillomas. We sought to determine the indication for surgical excision, incidence of malignancy, significance, and natural history. Methods In this retrospective review, patients were divided into benign, atypical, or malignant cohorts based on initial results. While patients with malignant or atypical features were encouraged to undergo surgical excision, no standard recommendation was given for benign papillomas. Mammographic features, method of initial diagnosis, pathology results, and follow-up data were analyzed. Results Between January 1994 to December 2005, 5,257 CNBs were performed at our tertiary level medical center. 206 patients were diagnosed with 215 breast papillomas. 174 (81%) papillomas were benign, 26 (12%) were associated with atypia, and 15 (7%) were associated with malignancy. Two benign papillomas (1.1%) developed into cancer over an average of 53 months. Average follow-up of those patients not undergoing excision for benign papilloma was 41 months; we had 92 patients with greater than two year follow-up and 57 patients with greater than four year follow-up. Of patients with atypia or malignancy associated with papilloma, there was a 26% and 87% associated rate of malignancy, respectively. Conclusions Benign breast papillomas diagnosed by CNB have a low risk of malignancy and do not need excision. However, they should be considered high risk lesions which require serial radiographic monitoring. Papillomas associated with atypia or malignancy should continue to be excised.     

Breast conservative surgery for well-differentiated ductal intraepithelial neoplasia: Risk factors for ipsilateral breast tumor recurrence

RationalWe retrospectively analyzed 232 patients affected by well differentiated ductal intraepithelial neoplasia (DIN1c or DCIS G1) treated with conservative surgery without adjuvant radiotherapy.Results25 invasive and 18 non-invasive local recurrences were observed (median follow-up 80 months; 5-year cumulative incidence: 12.2%). Seven of the 15 young patients (<40 y) developed local recurrence (2 in situ, 5 invasive). Age <50 (HR 1.89, 95% C.I. 1.01–3.45), multifocality (HR 3.21, 95% C.I. 1.46–7.06), Ki-67 > 7% (HR 2.33, 95% C.I. 1.20–4.55) and surgical margins <10 mm (HR 2.00, 95% C.I. 1.06–3.76) were significantly associated with an increased risk of local recurrence.ConclusionsYoung age, multifocality and small margins appeared as clear risk factors of local recurrence in DIN1c (DCIS G1) population. The presence of multiple poor prognostic features warrant a thorough discussion regarding local treatment.     

Presence of Lobular Carcinoma In Situ Does Not Increase Local Recurrence in Patients Treated with Breast-Conserving Therapy

Background  Lobular carcinoma in situ (LCIS) is known to be a risk factor for the development of invasive breast cancer. Debate continues as to whether LCIS is also a precursor lesion. We hypothesized that, if LCIS were a precursor, its presence in the lumpectomy specimen, particularly at the margin, could increase local recurrence (LR) after breast-conserving therapy (BCT). Methods  2894 patients treated with BCT for ductal carcinoma in situ (DCIS), stage I or II breast cancer between 1/80 and 5/07 were identified. Patients with DCIS or invasive cancer at the margins or those receiving neoadjuvant therapy were excluded. Group A had 290 patients with LCIS in the lumpectomy; 84 had LCIS at the final margin. Group B included 2604 patients with no evidence of LCIS. Results  Median patient age in group A and B was 57 and 58 years, respectively (P = 0.05); 12% and 13%, respectively, of patients in group A and B had margins <2 mm (P = NS). The histologic distribution of tumor types in group A was lobular in 47.2%, ductal in 34.5%, DCIS in 11.4%, and other invasive histologies in 6.9%, compared with 4.1%, 76.3%,13.6%, and 6.0% for group B, respectively (P < 0.0001). There was no significant difference between the groups in tumor–node–metastasis (TNM) stage. The crude rate of LR was 4.5% in group A and 3.8% in group B (P = NS). Five- and 10-year actuarial LR rates for LCIS at the margin were 6% and 6%, 1% and 15% for LCIS present but not at the margin, and 2% and 6% for no LCIS (P = NS), for group A and B, respectively. In multivariate analysis, menopausal status and adjuvant therapy use were significant predictors of LR. LCIS, either in the specimen or at the margin, was not significantly associated with LR. Conclusion  Presence of LCIS, even at the margin, in BCT specimens does not have an impact on LR. Re-excision is not indicated if LCIS is present or close to margin surfaces. These findings do not support consideration of LCIS as a precursor to the development of invasive lesions. Abstract presentation at the Scientific Session of the 61st Annual Cancer Symposiumof the Society of Surgical Oncology, Chicago, IL, March 13–16, 2008.     

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 conservation surgery for ductal carcinoma in situ (DCIS). The objective of this study was to determine whether mastectomy specimen radiography could help in obtaining negative resection margins in patients with DCIS undergoing skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR).Methods: Of 95 patients treated at our institution with SSM and IBR for DCIS, 35 had specimen radiography. The mastectomy specimen was first examined grossly and then inked, serially sectioned, and sent for radiographic assessment. Tissue slices containing calcifications were identified for pathologic evaluation. Additional tissue was excised if tumor was found near the inked 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 close 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 mastectomy specimen radiography and histology in 77% of the patients. Of the 95 patients 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 follow-up. At a median follow-up time of 3.7 years, 93 patients (98%) were alive and free of disease.Conclusions: Intraoperative radiography of mastectomy specimens may be useful for assessing margin status and for identifying the location of microcalcifications within tissue slices.