World Journal of Surgery

, 32:2599

Accuracy of Frozen Section Analysis Versus Specimen Radiography During Breast-Conserving Surgery for Nonpalpable Lesions

  • Walter P. Weber
  • Stephan Engelberger
  • Carsten T. Viehl
  • Rosanna Zanetti-Dallenbach
  • Salome Kuster
  • Stephan Dirnhofer
  • Daniela Wruk
  • Daniel Oertli
  • Walter R. Marti
Article

Abstract

Background

Whereas specimen radiography (SR) is an established strategy for intraoperative resection margin analysis during breast-conserving surgery for nonpalpable lesions, the use of frozen section analysis (FSA) is still a matter of debate.

Methods

A retrospective review was conducted of 115 consecutive operations in which the two objectives sought were the excision of nonpalpable malignant lesions and breast conservation. Breast surgery was performed in the Gynecology and the Surgery Departments at the Basel University Hospital Breast Center. Whereas one department preferably uses SR for intraoperative margin assessments of lesions involving ductal carcinoma in situ (DCIS) or atypical ductal hyperplasia, the other uses FSA to increase the rate of complete removal of these lesions with a single procedure. The respective accuracy and therapeutic impact of these two techniques are compared here.

Results

Intraoperative resection margin assessments were performed with FSA in 80 and SR in 35 of a total of 115 operations performed on 111 patients with pTis, pT1, or pT2 nonpalpable breast cancer. FSA diagnostic accuracy, sensitivity, and specificity were 83.8%, 80.0%, and 87.5%, respectively, compared to 60%, 60%, and 60%, respectively, for SR. FSA tended to have a stronger therapeutic impact than SR in terms of the number of patients in whom initially positive margins were rendered margin-negative thanks to intraoperative analysis and immediate reexcision or mastectomy (27.5% vs. 14.3%; p = 0.124). More importantly, significantly fewer secondary reexcisions were performed in the FSA series than in the SR series (12.5% vs. 37.1%; p = 0.002). Finally, the intraoperative detection of invasive cancer with FSA led to a significantly lower number of secondary procedures for axillary lymph node staging (5% vs. 25.7%; p = 0.001).

Conclusions

The present results suggest that FSA may be more accurate than SR for analyzing intraoperative resection margins during breast-conserving surgery for nonpalpable lesions.

References

  1. 1.
    Arriagada R, Le MG, Rochard F et al (1996) Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data; Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol 14:1558–1564PubMedGoogle Scholar
  2. 2.
    Fisher B, Redmond C, Poisson R et al (1989) Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 320:822–828PubMedGoogle Scholar
  3. 3.
    Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241PubMedCrossRefGoogle Scholar
  4. 4.
    Jacobson JA, Danforth DN, Cowan KH et al (1995) Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 332:907–911PubMedCrossRefGoogle Scholar
  5. 5.
    Veronesi U, Banfi A, Salvadori B et al (1990) Breast conservation is the treatment of choice in small breast cancer: long-term results of a randomized trial. Eur J Cancer 26:668–670PubMedCrossRefGoogle Scholar
  6. 6.
    Ernster VL, Barclay J, Kerlikowske K et al (1996) Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA 275:913–918PubMedCrossRefGoogle Scholar
  7. 7.
    Ernster VL, Ballard-Barbash R, Barlow WE et al (2002) Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst 94:1546–1554PubMedGoogle Scholar
  8. 8.
    Weber WP, Zanetti R, Langer I et al (2005) Mammotome: less invasive than ABBI with similar accuracy for early breast cancer detection. World J Surg 29:495–499PubMedCrossRefGoogle Scholar
  9. 9.
    Letton AH, Mason EM (1980) The treatment of nonpalpable carcinoma of the breast. Cancer 46:980–982PubMedCrossRefGoogle Scholar
  10. 10.
    Rosen PP (1991) Pathological assessment of nonpalpable breast lesions. Semin Surg Oncol 7:257–260PubMedCrossRefGoogle Scholar
  11. 11.
    Snyder RE (1980) Specimen radiography and preoperative localization of nonpalpable breast cancer. Cancer 46:950–956PubMedCrossRefGoogle Scholar
  12. 12.
    Graham RA, Homer MJ, Sigler CJ et al (1994) The efficacy of specimen radiography in evaluating the surgical margins of impalpable breast carcinoma. AJR Am J Roentgenol 162:33–36PubMedGoogle Scholar
  13. 13.
    Mazouni C, Rouzier R, Balleyguier C et al (2006) Specimen radiography as predictor of resection margin status in non-palpable breast lesions. Clin Radiol 61:789–796PubMedCrossRefGoogle Scholar
  14. 14.
    Sakorafas GH, Farley DR (2003) Optimal management of ductal carcinoma in situ of the breast. Surg Oncol 12:221–240PubMedCrossRefGoogle Scholar
  15. 15.
    Klimberg VS, Harms S, Korourian S (1999) Assessing margin status. Surg Oncol 8:77–84PubMedCrossRefGoogle Scholar
  16. 16.
    Cabioglu N, Hunt KK, Sahin AA et al (2007) Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol 14:1458–1471PubMedCrossRefGoogle Scholar
  17. 17.
    Camp ER, McAuliffe PF, Gilroy JS et al (2005) Minimizing local recurrence after breast conserving therapy using intraoperative shaved margins to determine pathologic tumor clearance. J Am Coll Surg 201:855–861PubMedCrossRefGoogle Scholar
  18. 18.
    Cendan JC, Coco D, Copeland EMIII (2005) Accuracy of intraoperative frozen-section analysis of breast cancer lumpectomy-bed margins. J Am Coll Surg 201:194–198PubMedCrossRefGoogle Scholar
  19. 19.
    Weber S, Storm FK, Stitt J et al (1997) The role of frozen section analysis of margins during breast conservation surgery. Cancer J Sci Am 3:273–277PubMedGoogle Scholar
  20. 20.
    Greene FL, Page DL, Fleming ID (2002) AJCC Cancer staging manual, 6th edn. Springer, New York, p 223Google Scholar
  21. 21.
    Walter SD (1998) Sensitivity. In: Armitage P, Colton T (eds) Encyclopedia of biostatistics. Toronto, Wiley, pp 4053–4054Google Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Walter P. Weber
    • 1
  • Stephan Engelberger
    • 1
  • Carsten T. Viehl
    • 1
  • Rosanna Zanetti-Dallenbach
    • 2
  • Salome Kuster
    • 3
  • Stephan Dirnhofer
    • 4
  • Daniela Wruk
    • 5
  • Daniel Oertli
    • 1
  • Walter R. Marti
    • 1
  1. 1.Department of SurgeryUniversity Hospital of BaselBaselSwitzerland
  2. 2.Department of GynecologyUniversity Hospital of BaselBaselSwitzerland
  3. 3.Department of AnesthesiaUniversity Hospital of BaselBaselSwitzerland
  4. 4.Department of PathologyUniversity Hospital of BaselBaselSwitzerland
  5. 5.Department of RadiologyUniversity Hospital of BaselBaselSwitzerland

Personalised recommendations