Research & Events

Research & Events2020-02-24T16:56:10-05:00

New Research:
More accurate re-excisions using

Intraoperative inking is superior to suture marking for specimen orientation in breast cancer

Ariella M. Altman MD1 | David D. Nguyen MD1 | Benjamin Johnson BA1 | Schelomo Marmor MPH PhD1 | Molly E. Klein MD2 | Todd M. Tuttle MD MS1 | Jane Yuet Ching Hui MD MS1

1Department of Surgery,
Division of

Surgical Oncology, University
of Minnesota,

Minneapolis, MN, USA

2Department of Laboratory
Medicine and Pathology,
University of Minnesota,

Minneapolis, MN, USA

Jane Yuet Ching Hui,
Department of

Surgery, Division of Surgical

University of Minnesota,
420 Delaware St

SE, Mayo Mail Code 195,
Minneapolis, MN

55455, USA.

Funding Information
This work was in part funded
by the Institute

for Basic and Applied
Research in Surgery

and the VFW Fund of
the University of


Margin status is an important indicator of residual disease after breast‐conserving surgery (BCS). Intraoperatively, surgeons orient specimens to aid assessment of margins and guide re‐excision of positive margins. We performed a retrospective review of BCS cases from 2013 to 2017 to compare the two specimen orientation methods: suture marking and intraoperative inking. Patients with ductal carcinoma in situ, T1/ T2 invasive cancer treated with BCS were included. Rates of positive margins and residual disease at re‐excision were evaluated. 189 patients underwent BCS; 83 had suture marking, 103 had intraoperative inking and 3 had un‐oriented specimens. The incidence of positive margins was 29% (24 patients) in the suture marked group and 20% (21 patients) in the intraoperative inked group (P = .18). Among the 45 patients with positive margins, 60% of tumors were stage T1, 76% were node negative, 36% were palpable with median tumor size of 1.5 cm. Residual disease was identified on re‐excision in 21% of the suture marked specimens and 57% of intraoperative inked specimens (P = .028). The incidence of residual cancer at re‐excision for positive margins was higher for intraoperatively inked versus suture marked specimens. This finding suggests that intraoperative inking is more effective at guiding re‐excision of positive margins.

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