Excisional Breast Specimen Orientation/Processing: A Multidisciplinary Approach for Breast Conservation

Breast carcinoma is the most frequently diagnosed malignancy in women of North America. The combination of breast conservation surgery and radiotherapy has become a standard of treatment for the majority of breast cancers. It is critical to obtain clear margins to minimize local recurrence. However avoiding multiple re-excisions for margin clearance helps optimize cosmetic results in patients undergoing breast conservation surgery. Careful attention to the details of peri-operative evaluation and management are critical for success. The objective of this article is to define safe and effective techniques of preoperative planning and intraoperative breast specimen orientation and processing. The importance of a multidisciplinary approach with excellent communication between team members is stressed. Accurate pre-operative diagnosis, precise localization of the area of concern, volume of the surgical excision, specimen orientation, specimen radiography, intraoperative margin evaluation, specimen inking, and pathology processing are discussed. The specifics of the policy for breast specimen handling will vary depending on the resources and expertise available at each treating facility. This paper describes the approach used at Beth Israel Medical Center.