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Intraoperative Imprint Cytology and Frozen Section Pathology for Margin Assessment in Breast Conservation Surgery: A Systematic Review

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Achieving negative surgical margins is critical to minimizing the risk of tumor recurrence in patients undergoing breast conservation surgery (BCS) for a breast malignancy. Our objective was to perform a systematic review comparing reexcision rates, sensitivity and specificity of the intraoperative use of the margin assessment techniques of imprint cytology (IC) and frozen section analysis (FSA), against permanent histopathologic section (PS).

Methods

The databases PubMed, Web of Knowledge, Cochrane Library and CINAHL Plus were searched for literature published from 1997 to 2011. Original investigations of patients who underwent BCS for breast cancer that evaluated margin assessment with PS and/or IC or FSA were included. Of 182 titles identified, 41 patient cohorts from 37 articles met inclusion criteria: PS (n = 19), IC (n = 7) and FSA (n = 15). Studies were summarized qualitatively using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cohort studies and the Strength of Recommendation Taxonomy (SORT) numerical scale for diagnostic studies.

Results

The final reexcision rates after primary BCS were 35 % for PS, 11 % for IC (p = 0.001 vs. PS) and 10 % for FSA (p < 0.0001 vs. PS). For IC, reexcision rates decreased from 26 to 4 % (p = 0.18) and for FSA, reexcision rates decreased from 27 to 6 % (p < 0.0001). The pooled sensitivity of IC and FSA were 72 and 83 %. The pooled specificity of IC and FSA were 97 and 95 %. The average length of each technique was 13 min for IC and 27 min for FSA.

Conclusions

Patients who underwent BCS with intraoperative IC or FSA to assess negative surgical margins had significantly fewer secondary surgical procedures for excision of their breast malignancies.

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Acknowledgment

K.E. is supported by National Institutes of Health Grant 5R01CA114462-02 under Dr. Patricia Keely and by the Clinical and Translational Science Award (CTSA) program, previously through the National Center for Research Resources (NCRR) Grant 1UL1RR025011, and now by the National Center for Advancing Translational Sciences (NCATS) Grant 9U54TR000021.

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Authors and Affiliations

  1. Department of Molecular and Regenerative Biology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Karla Esbona MS

  2. Institute of Clinical and Translational Research (ICTR), School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Karla Esbona MS & Zhanhai Li PhD

  3. Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Lee G. Wilke MD

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  1. Karla Esbona MS
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Correspondence to Lee G. Wilke MD.

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Esbona, K., Li, Z. & Wilke, L.G. Intraoperative Imprint Cytology and Frozen Section Pathology for Margin Assessment in Breast Conservation Surgery: A Systematic Review. Ann Surg Oncol 19, 3236–3245 (2012). https://doi.org/10.1245/s10434-012-2492-2

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  • DOI: https://doi.org/10.1245/s10434-012-2492-2

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