Interoperative frozen section for margin assessment in breast conserving energy

Department of Surgery, Fatih University School of Medicine, Ankara, Turkey.
Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society (Impact Factor: 1.26). 02/2009; 98(1):34-40.
Source: PubMed


When excisional biopsy or lumpectomy is performed without margin assessment in early breast cancer, further surgery are required if positive margins exist. We evaluated the role of the intraoperative frozen section in breast conserving surgery (BCS). Clinicopathologic factors associated with re-excision were searched.
190 tumors in 186 patients with early invasive breast cancer treated by BCS. Breast tumor was excised with 2 cm macroscopic margin, and microscopic margins examined by intraoperative frozen section.
After frozen section, 160 cases had negative margins (no re-excision), but 30 patients (16%) underwent re-excision because of close/positive margins. Negative margins were obtained in 24 patients but six patients underwent mastectomy due to persistent involved margins. Local recurrence was 2.1% and systematic recurrence was 2.6% with mean 62 months follow up. Tumor type, tumor size, extranodal extension and extensive intraductal component were significant predictors of re-excision by multivariate analysis. Re-excision procedures haven't an impact on local recurrence.
Interoperative frozen section is an effective procedure in reducing the need of second operation. We have observed lower recurrence rates than other studies because of our 2 cm macroscopic margin width and > 2 mm microscopic negative margin which is obtained by interoperative frozen section.

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    • "frozen section analysis (FSA) [13] [14], radio-frequency spectroscopy (RFS) [15], tomography (TM) [2], and Raman spectroscopy (RS) [16] [17], each of which have various limitations with false negative diagnoses in 20–50% of the patients or prolong surgical time [18]. Although RFS, TM, and RS are more sensitive than TPC, they are limited by their dependence on tissue homogeneity. "
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    ABSTRACT: Positive margins have been a critical issue that hinders the success of breast- conserving surgery. The incidence of positive margins is estimated to range from 20% to as high as 60%. Currently, there is no effective intraoperative method for margin assessment. It would be desirable if there is a rapid and reliable breast cancer margin assessment tool in the operating room so that further surgery can be continued if necessary to reduce re-excision rate. In this study, we seek to develop a sensitive and specific molecular probe to help surgeons assess if the surgical margin is clean. The molecular probe consists of the unique aqueous quantum dots developed in our laboratory conjugated with antibodies specific to breast cancer markers such as Tn-antigen. Excised tumors from tumor-bearing nude mice were used to demonstrate the method. AQD-Tn mAb probe proved to be sensitive and specific to identify cancer area quantitatively without being affected by the heterogeneity of the tissue. The integrity of the surgical specimen was not affected by the AQD treatment. Furthermore, AQD-Tn mAb method could determine margin status within 30 minutes of tumor excision, indicating its potential as an accurate intraoperative margin assessment method.
    Full-text · Article · Dec 2012 · International Journal of Surgical Oncology
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    • "The use of intraoperative frozen section for assessment of margins, where available, is helpful in reducing the number of second procedures required to achieve clear margins [33, 34]. A further cavity shave can be taken from any margin found to be positive on intraoperative frozen section. "
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    ABSTRACT: Breast conservation surgery is available to the vast majority of women with breast cancer. The combination of neoadjuvant therapies and oncoplastic surgical techniques allows even large tumours to be managed with a breast-conserving approach. The relationship between breast size and the volume of tissue to be excised determines the need for volume displacement or replacement. Such an approach can also be used in the management of carefully selected cases of multifocal or multicentric breast cancer. The role of novel techniques, such as endoscopic breast surgery and radiofrequency ablation, is yet to be precisely defined.
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