Surgeon interpretation of intraoperative 3D tomosynthesis images offers sensitivity comparable to a multidisciplinary standard practice for detecting positive margins during breast-conserving surgery, with meaningfully higher specificity and a fraction of the time investment. The authors suggest this approach could reduce unnecessary shave margins without compromising oncologic safety, easing the resource burden that intraoperative margin assessment places on breast pathology and radiology teams.

Atypical ductal hyperplasia (ADH) diagnosed on core biopsy is associated with an upgrade risk to ductal carcinoma in situ (DCIS) or invasive carcinoma on surgical excision.

The intra-operative use of the 3D specimen tomosynthesis function could potentially save 20-50% of patients from a second operation. This would lead to a significant improvement in patient outcomes and a reduction in the cost of healthcare provision.

Use of the 3D specimen tomosynthesis slices intra-operatively could reduce re-excision rates compared to 2D composite view by 20% when images are reviewed by the surgeon alone intraoperatively. If a breast radiologist were to report the 3D images intra-operatively, 50% of patients could have avoided re-excision. This would lead to a significant improvement in patient outcomes and a reduction in healthcare provision costs.

Breast specimen radiography is essential to ensure adequate excision of lesions of interest. Intra-operative breast specimen radiography by surgeons is a safe and reliable technique with a shorter total operative time. This study encourages a shift towards surgeons utilizing intra-operative specimen radiography in breast surgery.

The XPERT 80 and XPERT 80-L by KUBTEC are self-contained X-ray imaging systems for surgical pathology specimens. The XPERT 80 system provides a large 23 x 29 cm detector and is not limited to breast specimens, including paraffin blocks, bone, etc.