Improving breast conserving surgery using the Faxitron™ OR Specimen Radiography System - complication analysis, cost evaluation and literature review
Eichler C.1, Westerhoff A.2, Warm M.3, Puppe J.4, Krug B.5, Malter W.4
1University of Cologne, Breast Cancer Center, Cologne, Deutschland, 2Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Deutschland, 3Kliniken der Stadt Köln, Holweide, Brustzentrum, Köln, Deutschland, 4Department of Gynecology and Obstetrics, University of Cologne, Cologne, Deutschland, 5Department of Radiology, University of Cologne Medical School, Cologne, Deutschland

Purpose: A combination of pre-surgical clip placement and hook-wire guided surgery is currently considered the gold standard in order to adequately locate non-palpable lesions during breast conserving surgery. After surgical removal of the segment, radiography, carried out in a distant radiological unit, is required in order to confirm clip removal. This step generally increases surgical time which in turn is thought to increase post-surgical complication rates. Since May 2019 the Breast Cancer Center of the Department of Gynecology and Obstetrics at the University of Cologne, Germany, uses the intraoperative Faxitron™ OR Specimen Radiography System, Hollogic, which allows an on-site evaluation of removed breast segment.
Patients and methods: We performed a retrospective analysis with the primary endpoints: surgical time and complication rates. The secondary endpoints were cost effectiveness, correct clip-location rates and relative segment sizes. The control cohort consisted of 150 breast conserving surgery patients prior to May 2019 The validation cohort comprised 50* breast conserving surgery patients after May 2019.
Results: This interim analysis showed shorter surgical times directly linked to a benefit in cost effectiveness. A numerical benefit in complication rates could also be shown. Clip location rates and relative segment sizes did not differ significantly. Data on relative segment size is not mature yet (ongoing analysis). Our data are consistent with reported literature.
Discussion: The use of intraoperative specimen radiography significantly reduces surgical time thus maintaining low complication rates and increasing cost efficiency while maintaining high standards of patient care.

*This is a preliminary analysis, numbers may vary.