Attending surgeon at MedStar Georgetown, Ian Greenwalt, MD provides two cases where he utilized the MOZART® Specimen Tomosynthesis Imaging System from KUBTEC Medical Imaging. Dr. Greenwalt shares the operating plans for each case and how 3D tomosynthesis technology aided in real-time intraoperative decision-making.

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‍‍“It gives me one more tool in the operating room to be as accurate as possible” - Dr. Ian T. Greenwalt

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‍Case #1

• 61F postmenopausal h/o anxiety, fibromyalgia, OSA, lyme disease (well controlled, no steroids, biologics) mother h/o breast ca at 47. Previous right breast biopsy (benign). No complaints, asymptomatic, exam within normal limits.

• Bilateral sMMG – Cluster of classifications right superior breast. BI-RADS: 0-incomplete, recommended for additional imaging.

• Right dMMG - suspicious calcifications in the right breast. Biopsy recommended.BI-RADS:

• Right breast stereotactic biopsy – R DCIS, grade II-III, ER >95% PR 80-90% (hydromark barrel)

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Case #2

• 64post-menopausal on HRT (insomnia, vaginal dryness) noted palpable abnormality in UOQ of L breast. Found to have 1 cm palpable mass on clinical exam and palpable   left axillary lymphadenopathy.

• Left dMMG & U/S – Left UOQ, 2OC 1.2 cm mass corresponding to palpable area of concern. Left axillary lymph node with thickened cortex 1.1 cm. BIRADS 4

• Left U/S guided biopsy – Left breast 2 OC: IDC, grade III, ER (100%) PR (100%) HER2negative, Ki 67 70% LeftAxilla – Poorly differentiated carcinoma consistent with metastasis from breast primary. Staging scans negative

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Discussion

•  How 3D tomosynthesis provides critical information about anterior and posterior margins relative calcifications in specimen that 2D imaging may have missed.

•  How 2mm margins are sufficient to understand the extend of calcifications within the specimen

•  How tomosynthesis and measurement features on machine are helpful to assess inferior margin.

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Surgeon Biography:

Dr. Ian T. Greenwalt is a board-certified breast surgeon practicing in the MedStar Breast Health Program at MedStar Georgetown University Hospital. A graduate of Boston College, Dr. Greenwalt received his medical degree from Drexel University College of Medicine.

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