Skip to main content
SpringerLink
Log in

Der Resektionsrand und seine Beurteilung

Resection margins and their assessment

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

In den letzten Jahren wurde eine intensive Diskussion um die Definition des freien Resektionsrandes geführt. Trotz der Wirkung von Strahlen- und Systemtherapie ist ein positiver Resektionsrand bei der brusterhaltenden und der ablativen Operation des Mammakarzinoms nach wie vor mit einer erhöhten Lokalrezidivrate assoziiert. Ein durch den Pathologen bestätigter positiver Resektionsrand führt daher zu Folgeoperationen, die für die Patientin in vielerlei Hinsicht belastend sind und die nachfolgende adjuvante Therapie verzögern können. Das Gebiet der intraoperativen Resektionsrandmessung wird intensiv beforscht, zahlreiche Methoden und Technologien wurden entwickelt, um den Brustoperateur zu unterstützen. Manche, wie Schnellschnittdiagnostik, Imprintzytologie, Ultraschall und Radiofrequenzspektroskopie, sind bereits in der klinischen Routine etabliert. Andere, wie Nahinfrarotbildgebung, Röntgendiffraktion, Hochfrequenzultraschall und Mikro-Computertomographie sind noch experimentell. In diesem Beitrag wird der aktuelle Stand der Definition eines freien Resektionsrandes behandelt und versucht, einen Überblick über die Techniken zur intraoperativen Resektionsrandbeurteilung zu geben.

Abstract

In recent years there has been an intensive discussion about how to define a negative surgical resection margin. Despite the impact of radiation and systemic therapy a positive margin in breast surgery is associated with an increased risk of local recurrence. Thus, a positive margin confirmed by the pathologist results in further surgery that is troublesome for the patient in several ways and can also delay the initiation of adjuvant treatment. Therefore, the field of intraoperative margin assessment was intensively investigated and methods and technologies have been developed to support the breast surgeon in the operating theater. Some of these developments, such as frozen sections, touch imprint cytology, intraoperative ultrasound and radiofrequency spectroscopy are now established in the clinical routine. Others, such as near-infrared optical imaging, X-ray diffraction, high-frequency ultrasound and micro-computed tomography (CT) are still in the experimental stage. This article illustrates the current status of defining a negative surgical margin and gives an overview of the various and innovative technologies for intraoperative margin assessment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Ahmed M, Douek M (2013) Intra-operative ultrasound versus wire-guided localization in the surgical management of non-palpable breast cancers: systematic review and meta-analysis. Breast Cancer Res Treat 140(3):435–446

    Article  CAS  PubMed  Google Scholar 

  2. Alkhateeb SM, Abdelkader MH, Bradley DA et al (2012) Breast tissue contrast-simulating materials using energy-dispersive X-ray diffraction. Appl Radiat Isot 70(7):1446–1450

    Article  CAS  PubMed  Google Scholar 

  3. Blair SL, Thompson K, Rococco J et al (2009) Attaining negative margins in breast-conservation operations: is there a consensus among breast surgeons? J Am Coll Surg 209(5):608–613

    Article  PubMed  Google Scholar 

  4. Bydlon TM, Barry WT, Kennedy SA et al (2012) Advancing optical imaging for breast margin assessment: an analysis of excisional time, cautery, and patent blue dye on underlying sources of contrast. Plos One 7(12):e51418

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Cabioglu N, Hunt KK, Sahin AA et al (2007) Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol 14(4):1458–1471

    Article  PubMed  Google Scholar 

  6. D’Halluin F, Tas P, Rouquette S et al (2009) Intra-operative touch preparation cytology following lumpectomy for breast cancer: a series of 400 procedures. Breast 18(4):248–253

    Article  PubMed  Google Scholar 

  7. Doyle TE, Factor RE, Ellefson CL et al (2011) High-frequency ultrasound for intraoperative margin assessments in breast conservation surgery: a feasibility study. BMC Cancer 11:444

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dunne C, Burke JP, Morrow M et al (2009) Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol 27(10):1615–1620

    Article  PubMed  Google Scholar 

  9. Eggemann H, Ignatov T, Beni A et al (2014) Ultrasonography-guided breast-conserving surgery is superior to palpation-guided surgery for palpable breast cancer. Clin Breast Cancer 14(1):40–45

    Article  PubMed  Google Scholar 

  10. Eggemann H, Ignatov T, Costa SD (2014) Accuracy of ultrasound-guided breast-conserving surgery in the determination of adequate surgical margins. Breast Cancer Res Treat 145(1):129–136

    Article  PubMed  Google Scholar 

  11. Esbona K, Li Z, Wilke LG (2012) Intraoperative imprint cytology and frozen section pathology for margin assessment in breast conservation surgery: a systematic review. Ann Surg Oncol 19(10):3236–3245

    Article  PubMed  PubMed Central  Google Scholar 

  12. Haka AS, Volynskaya Z, Gardecki JA et al (2009) Diagnosing breast cancer using Raman spectroscopy: prospective analysis. J Biomed Opt 14:054023

    Article  PubMed  PubMed Central  Google Scholar 

  13. Houssami N, Macaskill P, Marinovich ML et al (2010) Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer 46(18):3219–3232

    Article  PubMed  Google Scholar 

  14. Houssami N, Macaskill P, Marinovich ML et al (2014) The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol 21(3):717–730

    Article  PubMed  Google Scholar 

  15. Jeong JW, Shin DC, Do SH et al (2008) Differentiation of cancerous lesions in excised human breast specimens using multiband attenuation profiles from ultrasonic transmission tomography. J Ultrasound Med 27(3):435–451

    PubMed  Google Scholar 

  16. Keller MD, Majumder SK, Mahadevan-Lansen A (2009) Spatially offset Raman spectroscopy of layered soft tissues. Opt Lett 34:926–928

    Article  PubMed  Google Scholar 

  17. Klimberg VS, Westbrook KC, Korourian S (1998) Use of touch preps for diagnosis and evaluation of surgical margins in breast cancer. Ann Surg Oncol 5:220–226

    Article  CAS  PubMed  Google Scholar 

  18. Lue N, Kang JW, Yu CC et al (2012) Portable optical fiber probe-based spectroscopic scanner for rapid cancer diagnosis: a new tool for intraoperative margin assessment. Plos One 7(1):e30887

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Luker GD, Luker KE (2008) Optical imaging: current applications and future directions. J Nucl Med 49(1):1–4

    Article  PubMed  Google Scholar 

  20. Mohs AM, Mancini MC, Singhal S et al (2010) Hand-held spectroscopic device for in vivo and intraoperative tumor detection: contrast enhancement, detection sensitivity, and tissue penetration. Anal Chem 82(21):9058–9065

    Article  CAS  PubMed  Google Scholar 

  21. Moran MS, Schnitt SJ, Giuliano AE et al (2014) 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. J Clin Oncol 32(14):1507–1515

    Article  PubMed  Google Scholar 

  22. Nguyen PL, Taghian AG, Katz MS et al (2008) Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol 26(14):2373–2378

    Article  PubMed  Google Scholar 

  23. Olson TP, Harter J, Muñoz A et al (2007) Frozen section analysis for intraoperative margin assessment during breast-conserving surgery results in low rates of re-excision and local recurrence. Ann Surg Oncol 14(10):2953–2960

    Article  CAS  PubMed  Google Scholar 

  24. Riedl O, Fitzal F, Mader N et al (2009) Intraoperative frozen section analysis for breast-conserving therapy in 1016 patients with breast cancer. Eur J Surg Oncol 35(3):264–270

    Article  CAS  PubMed  Google Scholar 

  25. Taghian A, Mohiuddin M, Jagsi R et al (2005) Current perceptions regarding surgical margin status after breast-conserving therapy: results of a survey. Ann Surg 241(4):629–639

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tang R, Buckley JM, Fernandez L et al (2013) Micro-computed tomography (Micro-CT): a novel approach for intraoperative breast cancer specimen imaging. Breast Cancer Res Treat 139(2):311–316

    Article  PubMed  Google Scholar 

  27. Tang R, Coopey SB, Buckley JM et al (2013) A pilot study evaluating shaved cavity margins with micro-computed tomography: a novel method for predicting lumpectomy margin status intraoperatively. Breast J 19(5):485–489

    PubMed  Google Scholar 

  28. Thill M (2013) MarginProbe: intraoperative margin assessment during breast conserving surgery by using radiofrequency spectroscopy. Expert Rev Med Devices 10(3):301–315

    Article  CAS  PubMed  Google Scholar 

  29. Thill M, Dittmer C, Baumann K et al (2014) MarginProbe(®) – Final results of the German post-market study in breast conserving surgery of ductal carcinoma in situ. Breast 23(1):94–96

    Article  PubMed  Google Scholar 

  30. Thill M, Baumann K, Barinoff J (2014) Intraoperative assessment of margins in breast conservative surgery-still in use? J Surg Oncol 110(1):15–20

    Article  PubMed  Google Scholar 

  31. Wang SY, Chu H, Shamliyan T, Jalal H, Kuntz KM, Kane RL, Virnig BA (2012) Network meta-analysis of margin threshold for women with ductal carcinoma in situ. J Natl Cancer Inst 104(7):507–516

    Article  PubMed  PubMed Central  Google Scholar 

  32. Zysk AM, Chen K, Gabrielson E et al (2015) Intraoperative assessment of final margins with a Handheld optical imaging probe during breast-conserving surgery may reduce the reoperation rate: results of a multicenter study. Ann Surg Oncol 22(10):3356–3362

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Gynäkologie und Geburtshilfe, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Straße 4, 60431, Frankfurt am Main, Deutschland

    Marc Thill & Jana Barinoff

  2. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    Friederike Hoellen

  3. Brustzentrum, Vivantes Klinikum am Urban, Berlin, Deutschland

    Andree Faridi

Authors
  1. Marc Thill
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jana Barinoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Friederike Hoellen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andree Faridi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marc Thill.

Ethics declarations

Interessenkonflikt

M. Thill gibt an, dass er Vortragshonorare der Firma Dune Medical erhalten hat.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Additional information

Redaktion

M. Thill, Frankfurt

K. Diedrich, Hamburg

D. Wallwiener, Tübingen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thill, M., Barinoff, J., Hoellen, F. et al. Der Resektionsrand und seine Beurteilung. Gynäkologe 49, 152–158 (2016). https://doi.org/10.1007/s00129-015-3798-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00129-015-3798-5

Schlüsselwörter

Keywords

Search

Navigation