Intraoperative inking is superior to suture marking for specimen orientation in breast cancer

Ariella M. Altman, David D. Nguyen, Benjamin Johnson, Schelomo Marmor, Molly E. Klein, Todd M. Tuttle, Jane Yuet Ching Hui

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Margin status is an important indicator of residual disease after breast-conserving surgery (BCS). Intraoperatively, surgeons orient specimens to aid assessment of margins and guide re-excision of positive margins. We performed a retrospective review of BCS cases from 2013 to 2017 to compare the two specimen orientation methods: suture marking and intraoperative inking. Patients with ductal carcinoma in situ, T1/T2 invasive cancer treated with BCS were included. Rates of positive margins and residual disease at re-excision were evaluated. 189 patients underwent BCS; 83 had suture marking, 103 had intraoperative inking and 3 had un-oriented specimens. The incidence of positive margins was 29% (24 patients) in the suture marked group and 20% (21 patients) in the intraoperative inked group (P =.18). Among the 45 patients with positive margins, 60% of tumors were stage T1, 76% were node negative, 36% were palpable with median tumor size of 1.5 cm. Residual disease was identified on re-excision in 21% of the suture marked specimens and 57% of intraoperative inked specimens (P =.028). The incidence of residual cancer at re-excision for positive margins was higher for intraoperatively inked versus suture marked specimens. This finding suggests that intraoperative inking is more effective at guiding re-excision of positive margins.

Original languageEnglish (US)
Pages (from-to)661-667
Number of pages7
JournalBreast Journal
Issue number4
StatePublished - Apr 1 2020

Bibliographical note

Funding Information:
This work was in part funded by the Institute for Basic and Applied Research in Surgery and the VFW Fund of the University of Minnesota. The authors of this manuscript would like to acknowledge and thank Stephanie Lundgren and the entire Division of Surgical Oncology at the University of Minnesota for their assistance with the production of this manuscript.

Publisher Copyright:
© 2019 Wiley Periodicals, Inc.


  • Breast-conserving surgery
  • breast cancer
  • margins
  • surgery

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't


Dive into the research topics of 'Intraoperative inking is superior to suture marking for specimen orientation in breast cancer'. Together they form a unique fingerprint.

Cite this