scholarly journals OBTAINING ADEQUATE SURGICAL MARGIN STATUS IN BREAST-CONSERVATION THERAPY: INTRAOPERATIVE ULTRASOUND-GUIDED RESECTION VERSUS SPECIMEN MAMMOGRAPHY

2018 ◽  
Vol 91 (2) ◽  
pp. 197-202
Author(s):  
Maria Mihaela Pop ◽  
Silviu Cristian ◽  
Orsolya Hanko-Bauer ◽  
Dana Valentina Ghiga ◽  
Rares Georgescu
Keyword(s):  
Sensitivity And Specificity ◽  
Breast Conservation ◽  
Intraoperative Ultrasound ◽  
Positive Margin ◽  
Margin Status ◽  
Resected Specimen ◽  
Margin Assessment ◽  
Positive Margins ◽  
Positive Correlation ◽  
Intraoperative Margin Assessment

Background and aim. The purpose of breast-conserving surgery (BCS) for women with cancer is to perform an oncological radical procedure with disease-free margins at the final histological assessment and with the best aesthetic result possible. Intraoperative resected specimen ultrasound and intraoperative resected specimen mammography may reduce the rates of positive margins and reexcision among patients undergoing conserving therapy. Our objective is to compare the two methods with the histopathological  results for a preset cut off and asses which parameters can influence the positive margin status.Method. A prospective study was performed on 83 patients who underwent breast conservation surgery for early breast cancer (pT1-3a pN0-1 M0) between 2014 and 2016. After excision the specimen was oriented in the operating room by the surgeon. Metallic clips and threads were placed on margins: one clip and the long thread at 12 o'clock, two clips and the short threads at 9 o'clock. The next step was intraoperative ultrasound assessment of the specimen. For the margins under 2 mm we performed selective margin shaving, followed by mammography to identify and document the lesion and finally histopathological examination of the specimen with reporting the gross and microscopic margins. The positive margins required re-excision or boost of radiation at the posterior or anterior margins, depending on the case.Results. We set a cut-off at 2 mm. The sensitivity and specificity of the intraoperative margin assessment via the ultrasound method were 90.91% (95% CI 70.84-98.88%) and 67.21% (95% CI 54-78.69%) respectively. The sensitivity and specificity of the intraoperative margin assessment via the mammographic procedure were 45.45% (95% CI 24.39-67.79%) and 85.25% (95% CI 73.83-93.02%) respectively. There was positive correlation between the histopathological and intraoperative ultrasound exam (p=0.018) and negative correlation between the histopathological exam and the post-operative mammographic exam (p=0.68). We found a positive correlation between the positive margin status and age (<40), preoperative chemotherapy, intraductal carcinoma, inflammatory process around the tumor, and the immunohistochemical triple negative profile.Conclusions. According to our results, the intraoperative ultrasound of the breast specimen for a cutt-off at 2 mm can decrease the rates of margin positivity compared to the mammographic procedure and has the potential to diminish the number of subsequent undesired re-excisions.

scholarly journals Intraoperative Evaluation of Resection Margins in Breast-Conserving Surgery for In Situ and Invasive Breast Carcinoma

2021 ◽  
Vol 15 ◽  
pp. 117822342199345
Author(s):  
Caroline Koopmansch ◽  
Jean-Christophe Noël ◽  
Calliope Maris ◽  
Philippe Simon ◽  
Marième Sy ◽  
...  
Keyword(s):  
Invasive Carcinoma ◽  
Tumour Size ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Resection Margins ◽  
Margin Assessment ◽  
Positive Margins ◽  
Intraoperative Assessment ◽  
Intraoperative Margin Assessment

Background: The challenge of breast-conserving surgery (BCS) is to remove the entire tumour with free margins and avoid secondary excision that may adversely affect the cosmetic outcome. Consequently, intraoperative evaluation of surgical margins is critical. The aims of this study were multiple. First, to analyse our methodology of intraoperative examination of the resection margins and to evaluate radiological and pathological methods in the assessment of the surgical margins. Second, to evaluate the factors associated with positive margins in our patient population. M&m: The data on the resection margin status of 290 patients who underwent BCS for invasive carcinoma or ductal carcinoma in situ (DCIS) between 2009 and 2016 were reviewed. Results: In the cohort of BCS with invasive carcinoma, the negative predictive value was 97.4% for intraoperative assessment by radiography and 81.8% for intraoperative assessment by pathology. The re-operation rate among cases without intraoperative assessment was 23.6% compared to 7.3% among cases with intraoperative assessment ( P = .003). Margin status was significantly associated with tumour size, histological subtype (invasive lobular carcinoma), and multifocality. In the population of BCS with DCIS, margin status was significantly associated with preoperative localisation and intraoperative margin assessment ( P = .03). Conclusion: There is no statistical difference between pathological and radiological intraoperative assessment. Tumour size, lobular subtype, and multifocality were found to be significantly associated with positive margins in cases with invasive carcinoma, whereas absence of intraoperative margin assessment was significantly associated with positive margins in cases with DCIS. Therefore, intraoperative margin assessment improves the likelihood of complete excision of the lesion.

Use of a novel device to reduce positive margins for ductal carcinoma in situ.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 87-87
Author(s):  
S. K. Boolbol ◽  
C. Cocilovo ◽  
L. Tafra
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conservation ◽  
Positive Margin ◽  
Standard Of Care ◽  
Positive Margins ◽  
Needle Localization ◽  
Novel Device

87 Background: The ability to obtain negative margins with a single surgical procedure remains a challenge, particularly in patients with ductal carcinoma in situ (DCIS). A novel device (MarginProbe, Dune Medical Devices, Inc.) is intended to provide surgeons with real-time, intraoperative detection of cancerous tissues at the margins of excised specimens. A study was performed to determine if there was a device-associated improvement in complete surgical resection (CSR) and therefore a decreased re-excision rate in patients with a DCIS component. Methods: 596 patients who were undergoing breast conservation using needle localization were randomized in a prospective, international, multicenter (n=21) study. Randomization occurred in the operating room, following standard of care lumpectomy, including palpation followed by indicated additional cavity resections. Device positive readings required additional resections of the cavity. Pathologists were blinded to study arm. A primary endpoint of this study was CSR, defined as the correct intraoperative identification and resection (if not skin or fascia) of all positive margins on the main lumpectomy specimen. Positive lumpectomy specimens were those having at least one margin having cancer ≤1mm from the surface. Successful CSR results in reduced positive margin rate after lumpectomy. Results: The improvement in CSR was significant for each diagnosis (p<0.0001). The decrease in candidates for reexcision due to failed CSR was significant for all pathology involving DCIS (p<0.0001). Overall results are presented in the table. Conclusions: Device use delivered significant improvement in CSR and therefore a significant decrease in reexcision rates for patients with DCIS. Further studies need to be conducted evaluating the use of the device on additional margins that the surgeon may resect or in the actual cavity. [Table: see text]

Margin status and neoadjuvant chemoradiation in patients with borderline resectable pancreatic cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 304-304
Author(s):  
Pavlos Papavasiliou ◽  
Jonathan R Piposar ◽  
Rodrigo Arrangoiz ◽  
Kathryn T Chen ◽  
Fang Zhu ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Disease Free Survival ◽  
Positive Margin ◽  
Neoadjuvant Chemoradiation ◽  
Margin Status ◽  
Negative Margin ◽  
Resectable Pancreatic Cancer ◽  
Consensus Definition ◽  
Borderline Resectable ◽  
Positive Margins

304 Background: The objective of this study was to examine the effect of margin status and neoadjuvant therapy in determining outcomes for borderline resectable (BLR) pancreatic cancer and how neoadjuvant chemoradiation impacts margin of resection. Methods: A retrospective chart review was conducted to identify patients who underwent resection for BLR pancreatic cancer based on the AHPBA/SSO/SSAT consensus definition. Outcomes including overall survival (OS) and disease free survival (DFS) were determined based on margin status, location of positive margin (artery, vein, or pancreas), and receipt of neoadjuvant chemoradiation. Results: One hundred and three patients who met the definition of BLR pancreatic cancer and underwent resection between April 1993 and July 2010 were reviewed. Mean age at diagnosis was 65 with a median follow up time of 19.7 months. Neoadjuvant chemoradiation was administered in 49.5% of patients. Twenty-five percent of patients underwent portal and/or superior mesenteric vein resection, and 7% hepatic artery resection. Microscopic positive margin rate was 54%. Median OS was 17.2 months for patients with positive margins versus 24.9 months for patients with negative margins (p=0.003). Median DFS was 13.1 months for patients with positive margins versus 18.6 months for patients with negative margins (p=0.001). There was no difference in OS or DFS for patients with positive margins based on location or number of positive margins. Of the patients who received neoadjuvant chemoradiation, 61.7% had a negative margin of resection versus a 38.3% negative margin of resection rate for patients who did not receive neoadjuvant chemoradiation (p=0.02). Among patients with a positive margin, there was no difference in OS or DFS with or without neoadjuvant chemoradiation. Conclusions: A positive margin of resection, irrespective of location or number, is associated with worse outcome in patients with BLR pancreatic cancer. The use of neoadjuvant chemoradiation is associated with higher rates of margin free resection.

An Assessment of Margins after Lumpectomy in Breast Cancer Management

2016 ◽  
Vol 82 (2) ◽  
pp. 156-160 ◽  
Author(s):  
Amy E. Rivere ◽  
Katherine F. Chiasson ◽  
Ralph L. Corsetti ◽  
George M. Fuhrman
Keyword(s):  
Breast Cancer ◽  
Breast Conservation ◽  
Positive Margin ◽  
Breast Conservation Therapy ◽  
Close Margin ◽  
Tumor Patients ◽  
Positive Margins ◽  
Cancer Management ◽  
Breast Cancer Management ◽  
Low Rate

We performed this study to evaluate our indications for margin re-excision (MRE) in the management of cancer patients opting for breast conservation therapy (BCT). We identified patients choosing breast conservation therapy from January 2012 to May 2014. Margins were considered negative if >2 mm, close if <2 mm, and positive if ink was detected abutting tumor. Patients with close and positive margins underwent MRE. We identified 247 patients of which 190 had negative margins and did not require MRE, 46 patients had a close margin, and 11 had a positive margin, leading to an MRE rate of 23 per cent (57 of 247). The following variables were evaluated: tumor size, stage, estrogen receptor, progesterone receptor, HER2/neu receptor, and node status. None predicted the presence of tumor in the MRE specimen ( P > 0.05). Patients with close margins had a 6.5 per cent (3 of 46), and patients with positive margins had a 36.4 per cent (4 of 11) incidence of tumor in the MRE specimens; this difference was statistically significant ( P = 0.02). The low rate of finding tumor in MRE specimens of patients with close margins after lumpectomy for breast carcinoma argues for limiting MRE to patients with positive margins (ink on tumor) only. We have adopted this approach in our institution.

scholarly journals Specimen oriented intraoperative margin assessment in oral cavity and oropharyngeal squamous cell carcinoma

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
P. Horwich ◽  
C. MacKay ◽  
M. Bullock ◽  
S. M. Taylor ◽  
R. Hart ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cohort Study ◽  
Frozen Section ◽  
Case Series ◽  
Margin Assessment ◽  
Retrospective Case ◽  
Positive Margins ◽  
Final Pathology ◽  
Primary Surgery ◽  
Intraoperative Margin Assessment

Abstract Objective Evaluate the oncologic outcomes and cost analysis of transitioning to a specimen oriented intraoperative margin assessment protocol from a tumour bed sampling protocol in oral cavity (OCSCC) and oropharyngeal squamous cell carcinoma (OPSCC). Study design Retrospective case series and subsequent prospective cohort study Setting Tertiary care academic teaching hospital Subjects and methods Retrospective case series of all institutional T1-T2 OCSCC or OPSCC treated with primary surgery between January 1st 2009 – December 31st 2014. Kaplan-Meier survival estimates with log rank tests were used to compare patients based on final margin status. Cost analysis was performed for escalation of therapy due to positive final margins. Following introduction of a specimen derived margin protocol, successive prospective cohort study of T1-T4 OCSCC or OPSCC treated with primary surgery from January 1st 2017 – December 31st 2018. Analysis and comparison of both protocols included review of intraoperative margins, final pathology and treatment cost. Results Analysis of our intra-operative tumour bed frozen section protocol revealed 15 of 116 (12.9%) patients had positive final pathology margins, resulting in post-operative escalation of therapy for 14/15 patients in the form of re-resection (7/14), radiation therapy (6/14) and chemoradiotherapy (1/14). One other patient with positive final margins received escalated therapy for additional negative prognostic factors. Recurrence free survival at 3 years was 88.4 and 50.7% for negative and positive final margins respectively (p = 0.048). Implementation of a specimen oriented frozen section protocol resulted in 1 of 111 patients (0.9%) having positive final pathology margins, a statistically significant decrease (p < 0.001). Utilizing our specimen oriented protocol, there was an absolute risk reduction for having a final positive margin of 12.0% and relative risk reduction of 93.0%. Estimated cost avoidance applying the specimen oriented protocol to our previous cohort was $412,052.812017 CAD. Conclusion Implementation of a specimen oriented intraoperative margin protocol provides a statistically significant decrease in final positive margins. This change in protocol leads to decreased patient morbidity by avoiding therapy escalation attributable only to positive margins, and avoids the economic costs of these treatments. Graphical abstract

scholarly journals Margin Status in Shave Biopsies of Nonmelanoma Skin Cancers: Is It Worth Reporting?

2016 ◽  
Vol 140 (7) ◽  
pp. 678-681 ◽  
Author(s):  
Alicia M. Schnebelen ◽  
Jerad M. Gardner ◽  
Sara C. Shalin
Keyword(s):  
Skin Cancer ◽  
Squamous Cell ◽  
Basal Cell ◽  
Positive Margin ◽  
Margin Status ◽  
Positive Margins ◽  
Reporting Practices ◽  
Skin Cancers ◽  
Basal Cell Carcinomas ◽  
Nonmelanoma Skin Cancers

Context.—The practice of reporting margin status in biopsies is relatively unique to biopsies of the skin and highly variable among pathologists. Objective.—To address the accuracy of margin evaluation in shave biopsies of nonmelanoma skin cancers. Design.—We collected shave biopsies of squamous and basal cell carcinomas that appeared to have uninvolved margins on routine sign out. We obtained deeper levels on corresponding tissue blocks until blocks were exhausted and examined them for tumor at biopsy margins. Results.—Forty-seven consecutive cases were collected, including 20 squamous cell (43%) and 27 basal cell (57%) carcinomas. Eleven of 47 cases (23%) with negative margins at initial diagnosis demonstrated positive margins upon deeper-level examination. Margins of 8 of 27 basal cell carcinomas (30%) and 3 of 20 squamous cell carcinomas (15%) were erroneously classified as “negative” on routine examination. Conclusions.—No guidelines exist regarding the reporting of margins in nonmelanoma skin cancer biopsies, and reporting practices vary extensively among pathologists. We found that nearly one-quarter of positive margins in shave biopsies for cutaneous carcinomas are missed on standard histologic examination. Moreover, reporting of a positive margin may also be misleading if the clinician has definitively treated the skin cancer at the time of biopsy. For these reasons, and as routine exhaustion of all tissue blocks is impractical, the decision to include or exclude a comment regarding the margin status should be given conscious consideration, accounting for the clinical intent of the biopsy and any known information regarding postbiopsy treatment.

Sign in / Sign up

Export Citation Format

Share Document