Is intraoperative frozen section analysis of reexcision specimens of value in preventing reoperation in breast-conserving therapy?

OBJECTIVES A prior study at our institution showed a marked reduction in reoperation for margin reexcision following the development of an intraoperative frozen section evaluation of margins (FSM) practice on lumpectomy specimens from patients undergoing breast-conserving therapy (BCT). This study aimed to examine the frequency of FSM utilization, FSM pathology performance, and outcomes for BCT patients undergoing margin reexcision only. METHODS Consecutive reexcision-only specimens were reviewed from a 40-month period following the development of the FSM practice. Clinicopathologic features and patient outcomes were assessed. RESULTS FSM was performed in 46 (30.7%) of 150 reexcision-only operations. Of the 46 operations with FSM, there were 28 (60.9%) true-negative, 12 (26.1%) true-positive, six (13.0%) false-negative, and no false-positive cases. There was no difference in further reexcision, total operations, or conversion to mastectomy among patients with and without FSM. Need for further reexcision was significantly associated with tumor multifocality (P = .008). CONCLUSIONS Despite overall good pathology performance for FSM in reexcision-only specimens, use of FSM did not affect patient outcome. Rather, underlying disease biology appeared most significant in predicting whether adequate surgical margins could be attained.

[1]  Malcolm Buchanan,et al.  Predictors of Surgical Margin Status in Breast-Conserving Surgery Within a Breast Screening Program , 2008, Annals of surgical oncology.

[2]  D. Wruk,et al.  Accuracy of Frozen Section Analysis Versus Specimen Radiography During Breast-Conserving Surgery for Nonpalpable Lesions , 2008, World Journal of Surgery.

[3]  M. Noguchi,et al.  Pathologic assessment of surgical margins on frozen and permanent sections in breast conserving surgery , 1995, Breast cancer.

[4]  M. Kitajima,et al.  Frozen-section-guided breast-conserving surgery: Implications of diagnosis by frozen section as a guide to determining the extent of resection , 1997, Surgery Today.

[5]  X. Pivot,et al.  Predictors of re-excision for positive or close margins in breast-conservation therapy for pT1 tumors. , 2008, American journal of surgery.

[6]  A. O'Doherty,et al.  Intraoperative margin assessment and re-excision rate in breast conserving surgery. , 2004, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[7]  B. Haffty,et al.  Negative margin status improves local control in conservatively managed breast cancer patients. , 2000, The cancer journal from Scientific American.

[8]  Alberto Luini,et al.  The surgical margin status after breast-conserving surgery: discussion of an open issue , 2008, Breast Cancer Research and Treatment.

[9]  W. P. Reed,et al.  The unsatisfactory margin in breast cancer surgery. , 1999, American journal of surgery.

[10]  Seema A. Khan,et al.  Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer , 2014, Annals of Surgical Oncology.

[11]  Reshma Jagsi,et al.  Residual disease after re‐excision lumpectomy for close margins , 2009, Journal of surgical oncology.

[12]  R. Carlson,et al.  Predictors of local recurrence after breast-conservation therapy. , 2005, Clinical breast cancer.

[13]  S. Jeffrey,et al.  The importance of the lumpectomy surgical margin status in long term results of breast conservation , 1995, Cancer.

[14]  M. Takeda,et al.  Total-circumference intraoperative frozen section analysis reduces margin-positive rate in breast-conservation surgery. , 2010, Japanese journal of clinical oncology.

[15]  U. W. Jayasinghe,et al.  Effect of margins on ipsilateral breast tumor recurrence after breast conservation therapy for lymph node‐negative breast carcinoma , 2004, Cancer.

[16]  C. Dener,et al.  Intraoperative Frozen Section for Margin Assessment in Breast Conserving Surgery , 2009 .

[17]  R. Arriagada,et al.  Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. , 1996, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[18]  L. Stitt,et al.  The effect of timing of radiotherapy after breast-conserving surgery in patients with positive or close resection margins, young age, and node-negative disease, with long term follow-up. , 2006, International journal of radiation oncology, biology, physics.

[19]  W. Al-Refaie,et al.  Are mastectomy rates really increasing in the United States? , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  D. Mahvi,et al.  Frozen Section Analysis for Intraoperative Margin Assessment During Breast-Conserving Surgery Results in Low Rates of Re-excision and Local Recurrence , 2007, Annals of Surgical Oncology.

[21]  M. Morrow,et al.  Effect of Time Interval on Residual Disease in Breast Cancer , 2003, The American journal of surgical pathology.

[22]  B. Eisenberg,et al.  Is frozen section analysis of reexcision lumpectomy margins worthwhile? Margin analysis in breast reexcisions , 1994, Cancer.

[23]  D. S. Lind,et al.  Minimizing local recurrence after breast conserving therapy using intraoperative shaved margins to determine pathologic tumor clearance. , 2005, Journal of the American College of Surgeons.

[24]  Yan Peng,et al.  Impact of Routine Cavity Shave Margins on Breast Cancer Re-excision Rates , 2011, Annals of Surgical Oncology.

[25]  B. E. F. Isher,et al.  Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. , 2002 .

[26]  R. Arriagada,et al.  Local relapse and contralateral tumor rates in patients with breast cancer treated with conservative surgery and radiotherapy (institut gustave roussy 1970–1982) , 1995, Cancer.

[27]  Jeffrey L Myers,et al.  Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center. , 2012, American journal of clinical pathology.

[28]  Mark C Kelley,et al.  Accuracy of Intraoperative Gross Examination of Surgical Margin Status in Women Undergoing Partial Mastectomy for Breast Malignancy , 2005, The American surgeon.

[29]  A. Hanlon,et al.  Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy. , 1999, International journal of radiation oncology, biology, physics.

[30]  L. Newman,et al.  Predictors of Re-excision among Women Undergoing Breast-Conserving Surgery for Cancer , 2008, Annals of Surgical Oncology.

[31]  M. Gnant,et al.  Intraoperative frozen section analysis for breast-conserving therapy in 1016 patients with breast cancer. , 2009, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[32]  Saveli Goldberg,et al.  Current Perceptions Regarding Surgical Margin Status After Breast-Conserving Therapy: Results of a Survey , 2005, Annals of surgery.

[33]  Y. Soini,et al.  Wire-guided excision of non-palpable breast cancer: determinants and correlations between radiologic and histologic margins and residual disease in re-excisions. , 2001, Breast.

[34]  Catherine C. Park,et al.  The relationship between pathologic margin status and outcome after breast-conserving therapy , 1998 .

[35]  M. Dillon,et al.  Factors Affecting Successful Breast Conservation for Ductal Carcinoma in Situ , 2007, Annals of surgical oncology.

[36]  I. Gage,et al.  Pathologic margin involvement and the risk of recurrence in patients treated with breast‐conserving therapy , 1996 .

[37]  S. Masood,et al.  Use of imprint cytology for assessment of surgical margins in lumpectomy specimens of breast cancer patients , 2007, Diagnostic cytopathology.

[38]  S. Singletary,et al.  Intraoperative margin assessment reduces reexcision rates in patients with ductal carcinoma in situ treated with breast-conserving surgery. , 2003, American journal of surgery.

[39]  S. Nicosia,et al.  Cytology of lumpectomy specimens. , 1991, Acta cytologica.

[40]  Kelly K. Hunt,et al.  Role for Intraoperative Margin Assessment in Patients Undergoing Breast-Conserving Surgery , 2007, Annals of Surgical Oncology.

[41]  P Okunieff,et al.  Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. , 1995, The New England journal of medicine.

[42]  R K Ten Haken,et al.  Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. , 1998, International journal of radiation oncology, biology, physics.