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Is breast specimen shrinkage really a problem in breast-conserving surgery?
  1. Nicole M A Krekel1,
  2. Henk Jan van Slooten2,
  3. Ellis Barbé3,
  4. Elly S M de Lange de Klerk4,
  5. Sybren Meijer1,
  6. M Petrousjka van den Tol1
  1. 1Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Department of Pathology, Medical Center Alkmaar, Alkmaar, The Netherlands
  3. 3Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
  4. 4Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Nicole M A Krekel, De Boelelaan 1117, Room 7F-020, Amsterdam 1081 HV, The Netherlands; n.krekel{at}vumc.nl

Abstract

Background Breast-conserving surgery currently focuses on improving margin clearance and excision volume, the main pathology report parameters for oncological and cosmetic outcomes.

Aim To quantitatively evaluate discrepancies in surgical and pathological estimates of breast specimen sizes, including the influence of formalin fixation.

Methods This prospective multicentre study included 68 breast specimens of consecutive patients undergoing breast-conserving surgery for breast cancer in three affiliated hospitals between November 2010 to May 2011. Specimens were weighed immediately after excision. Specimen volumes were calculated from the length, width and height. Actual specimen volumes were measured using volume displacement. Specimens were weighed once again after arrival at the pathology department, and volumes recalculated. The smallest pre- and post-fixation distances to the tumour-free margin were compared.

Results The mean surgical specimen weight was 47.7 g and was approximately similar to the actual specimen volume of 49.8 cm3. The weights of specimens immediately following surgery and on pathological appraisal were equal (p=0.94). The calculated volumes differed significantly from the actual specimen volumes (p>0.05). The mean distance to the closest tumour-free margin, 0.35 cm, was not altered by formalin fixation (p=0.1).

Conclusions No evidence was found to suggest that surgical breast specimens shrink in the period between the surgical procedure and pathological examination, or following formalin fixation. The pathological appraisal of specimen margins and volumes is not affected by changes in specimen size. As calculations of specimen volumes are unreliable, the use of water displacement or the more readily available specimen weight is recommended for accurate volume measurement. Pathologists should be encouraged to always measure and record specimen weight.

  • Breast-conserving surgery
  • tissue fixation
  • volume measurement
  • margin assessment
  • excision volume
  • breast cancer
  • breast pathology
  • breast
  • fixation
  • surgery
  • molecular biology
  • cancer research
  • circulating tumour cells
  • lymphoma
  • lymph node pathology
  • cytology
  • macrophages
  • management
  • laboratory management

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Footnotes

  • Funding This study was supported by the Dutch Pink Ribbon Foundation. The study sponsor was not involved in the study design, collection, analysis or interpretation of data, in the writing of the report, or in the decision to submit the paper for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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