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Background: Breast conservation therapy (BCT) is frequently performed for breast cancer and associated with a significant risk for positive margins. Intraoperative three-dimensional (3-D) tomosynthesis potentially could limit the risk of positive margins., Methods: Retrospective review of an institutional breast cancer registry. Evaluated BCT cases for a two year time period prior to and after the introduction of intraoperative 3-D tomosynthesis. Primary outcome was the effect of 3-D tomosynthesis on margin positivity rates. Secondary measures were the impact of 3-D tomosynthesis on additional margin procurements at the index surgery and operative time., Results: A total of 228 cases were evaluated with 106 cases utilizing 3-D tomosynthesis and 122 cases with standard imaging. No significant difference in margin positivity rates between the cohorts at 23.9% versus 15.8% for 3-D tomosynthesis and standard imaging respectively (OR 1.53, CI 0.772-3.032, P = 0.221). 3-D tomosynthesis was associated with increased margin procurement rates (OR 2.34, 95%CI 1.303-4.190, P = 0.004) and longer operative times (P < 0.001)., Conclusion: Intraoperative 3-D tomosynthesis was not found to limit margin positivity rates or improve the performance of the procedure., Competing Interests: Declaration of competing interest None of the authors have any conflicts of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Mount Sinai has licensed serological assays to commercial entities and has filed for patent protection for serological assays. Daniel Stadlbauer and Florian Krammer are listed as inventors on the pending patent application. No other potential conflicts of interest were disclosed.