Confocal Microscopy for Intraoperative Margin Assessment of Lumpectomies by Surgeons in Breast Cancer: Training, Implementation in Routine Practice, and Two-Year Retrospective Analysis

<b>Background:</b> Breast-conserving surgery (BCS) is recommended for early-stage breast cancer, with the aim of removing tumors while preserving breast tissue. Achieving clear margins is crucial to minimizing re-excision and recurrence risks. The Histolog^® Scanner (HS), a confocal laser microscopy device, enables real-time intraoperative margin assessments. This study describes surgeon training, HS integration into clinical practice, and its impact on surgical outcomes. <b>Methods:</b> One surgeon participated in an online training program related to Histolog image of breast tissue. We assessed the time and workload required for the surgeon's training, as well as the implementation of the HS into the surgical workflow. We retrospectively analyzed patients who underwent BCS with an intraoperative margin assessment performed by the trained surgeon using HS between December 2022 and January 2025. The re-excision rate was collected, and sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the final pathology assessment as the gold standard. <b>Results:</b> The surgeon completed the online training in 6 h 22 min over six days. HS integration into the routine workflow occurred smoothly. Retrospective analysis included 68 consecutive patients representing two years of clinical practice. The surgeon using the HS exhibited a sensitivity of 100%, specificity of 96.3%, accuracy of 96.9%, PPV of 85.7%, and NPV of 100%. Intraoperative HS usage eliminated re-excision in all cases. Integrating the HS into routine BCS procedures provides a highly accurate intraoperative margin assessment and significant reduction of re-excision rates.