Value of intraoperative frozen section analysis in re-excision margin evaluation in breast-conserving surgery for cancer: a single institution experience

Abstract Background. Previous studies have demonstrated that in women with breast cancer treated with breast-conserving surgery (BCS), intraoperative frozen section analysis of lumpectomy margins results in a decrease in reoperation rates for margin control. However, the value of intraoperative frozen margin evaluation (FME) in re-excision margin analysis is not fully understood. We analyzed our breast cancer database to identify the value of intraoperative frozen section examination of specimens additionally resected prior to BCS. Methods. We conducted a retrospective review of patients who underwent attempted BCS for breast cancer with routine intraoperative FME at our institution between January 1998 and May 2016. The number of FMEs was analyzed. We additionally analyzed factors associated with positive re-excised margins to identify correlations with patient characteristics. Results. Of the 760 patients who underwent attempted BCS with routinely conducted intraoperative FME, frozen sections were obtained from the initial margin only in 82.5% (n=627), the initial margin as well as a one-time re-excision analysis in 15.8% (n=120), or the initial margin and two or more re-excision analyses in 1.7% (n-13). Based on the results of FME, 727 (95.6%) of the patients underwent BCS, while the remaining 33 (4.4%) converted to mastectomy. Among the patients who underwent BCS, 112 (15.4%) had an initial positive margin on a FME, underwent one-time margin re-excision and achieved a margin-free status, while 1.6% underwent a second margin resection due to a positive result on the first re-excised margin. In total, 72.7% of the conversions to mastectomy were due to a positive initial margin. Univariate and multivariate analyses showed that patients with the ductal carcinoma in situ (DCIS) histological type were more likely to have repeatedly positive re-excised margins during BCS. Conclusion. While routine intraoperative FME of re-excised margins provided only limited value in patients who underwent attempted BCS, this method may be beneficial in the subgroup of patients with the DCIS histological type.

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The Efficacy of Intraoperative Frozen Section Analysis during Breast-Conserving Surgery for Patients with Ductal Carcinoma in Situ

Breast Cancer Basic and Clinical Research ◽

10.4137/bcbcr.s40868 ◽

2016 ◽

Vol 10 ◽

pp. BCBCR.S40868 ◽

Cited By ~ 3

Author(s):

Mi Jin Kim ◽

Cheol Seung Kim ◽

Young Sam Park ◽

Eun Hye Choi ◽

Kyu Dam Han

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Frozen Section ◽

Breast Conserving Surgery ◽

Resection Margins ◽

Intraoperative Frozen Section ◽

Frozen Section Analysis ◽

Section Analysis

Introduction Recently, the incidence of ductal carcinoma in situ (DCIS), a noninvasive breast malignancy, has increased. This has resulted in an increase in the incidence of breast-conserving surgery (BCS). Numerous studies have suggested that intraoperative frozen section analysis (IFSA) could reduce the rate of additional excisions required to obtain adequate resection margins. However, DCIS is a known risk factor for positive margin status during BCS. Furthermore, some authors have concluded that IFSA may not be reliable for the detection of DCIS. Aim The aim of this study was to evaluate the safety and efficacy of IFSA in patients with DCIS. Methods The operative and pathological reports of patients with DCIS, who underwent BCS at our institute between 2006 and 2015, were retrospectively reviewed. The results of IFSA and the pathological findings of final reanalyzed frozen tissue specimens were analyzed. Results In total, 25 patients were included in our analysis. None of the patients required additional operations. The correct diagnosis rate for IFSA was 89.6%, with a sensitivity and specificity of 60.0% and 95.8%, respectively. Conclusion IFSA could be beneficial for determining safety resection margins in patients with DCIS.

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