Fig. 26.1
An example of a dedicated specimen cabinet (Photo supplied by Claire Mercer, Lead Radiographer, Nightingale Centre, UHSM)
Types of Specimen Imaging and Reporting
There are three main types of specimen radiography in breast imaging:
1
Core biopsy specimens
2
Surgical excision specimens
3
Fixed pathological specimens
Core Biopsy Specimen Imaging
The imaging of core biopsy specimens, either standard 14 gauge or larger vacuum assisted biopsies, is usually to determine the presence of microcalcifications following stereotactic guided biopsies. This should be carried out prior to removal of the client from the mammography biopsy machine so further sampling can take place if calcification retrieval is inadequate (Fig. 26.2). Adequacy will be determined by the amount of calcification present before biopsy and local protocol. It has been suggested [3] that three or more cores containing calcification, or five flecks or more calcification in total, increases the likelihood of a successful biopsy and a definitive pathological diagnosis. Some pathologists prefer the separation of core biopsy samples containing calcification from those without calcification. This allows the pathologist to concentrate and sample more comprehensively those cores with known calcifications [4].
Fig. 26.2
Calcification identified in magnified core biopsy specimens
In core biopsy specimen reports, good practice would include the following:
the number of core samples obtained
the number of core samples which contain calcification
if a marker clip was deployed
the relationship between the marker clip and the area of calcification.
The report should be available to the pathologist before any multi-disciplinary team meeting (MDT) discussion takes place on future patient management in order to correlate radiologic and pathologic findings.
Surgical Excision Specimen Imaging
Specimen radiography of non-palpable lesions excised during breast conservation surgery should take place before skin closure and be available to the surgeon so that determination of total lesion removal can be achieved. Surgical clips, sutures or colour coded inking are often used to orientate the specimen [5]. If the lesion appears to extend to a margin the surgeon can make an appropriate further excision [6, 7]. An advantageous use of a specimen cabinet located in theatre would allow almost immediate results reducing theatre/anaesthetic time.
As radiography of a specimen is a two dimensional image of a three dimensional object, imaging in more than one plane can be useful but not always easy to do, due to the shape of the specimen. If using a mammography machine, careful and slow use of the compression paddle, can often achieve this (Fig. 26.3a, b).
