Abstract
Background
Intraoperative frozen section analysis of the surgical margins during breast-conserving surgery (BCS) for breast cancer can reliably achieve clear surgical margins and prevent re-operations. The aim of this study was to assess intraoperative entire-circumferential frozen section analysis (IEFSA) of the lumpectomy margins during BCS.
Methods
A total of 1029 patients who underwent BCS with IEFSA between June 2007 and July 2013 were available for assessment. The inner surfaces of the shaved lumpectomy margins were examined as frozen sections during BCS. The margins were defined as positive when the cancer cells were present within 5 mm from the edge of the outermost margins of the specimens.
Results
Out of 1029 patients, 312 patients (30.3 %) had positive margins after the initial lumpectomy and underwent additional resections during BCS. Fourteen patients (1.4 %) underwent mastectomy following the results of additional resections during the first surgery. Of 1015 patients who completed BCS, 60 patients (5.9 %) were found to have positive margins in the final pathology. One patient (0.1 %) underwent re-operation after BCS while the residual diseases of the other 59 patients were judged to be minimal. Of the 312 patients who were judged to have positive margins after the initial lumpectomy with IEFSA, 53 patients (16.9 %) were found to have negative margins in the final pathology. At a median follow-up time of 54.1 months, one patient (0.1 %) had a recurrence of breast cancer in the preserved breast.
Conclusion
IEFSA is useful for preventing the need for re-operation and local recurrence after BCS.
Similar content being viewed by others
Referrence
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(16):1233–1241. doi:10.1056/NEJMoa022152
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(14):907–911. doi:10.1056/nejm199504063321402
Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232. doi:10.1056/NEJMoa020989
Gage I, Schnitt SJ, Nixon AJ et al (1996) Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer 78(9):1921–1928
Leong C, Boyages J, Jayasinghe UW et al (2004) Effect of margins on ipsilateral breast tumor recurrence after breast conservation therapy for lymph node-negative breast carcinoma. Cancer 100(9):1823–1832. doi:10.1002/cncr.20153
Schnitt SJ, Abner A, Gelman R et al (1994) The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy. Cancer 74(6):1746–1751
Smitt MC, Nowels KW, Zdeblick MJ et al (1995) The importance of the lumpectomy surgical margin status in long-term results of breast conservation. Cancer 76(2):259–267
Weng EY, Juillard GJ, Parker RG et al (2000) Outcomes and factors impacting local recurrence of ductal carcinoma in situ. Cancer 88(7):1643–1649
Aziz D, Rawlinson E, Narod SA et al (2006) The role of reexcision for positive margins in optimizing local disease control after breast-conserving surgery for cancer. Breast J 12(4):331–337. doi:10.1111/j.1075-122X.2006.00271.x
Jacobson AF, Asad J, Boolbol SK et al (2008) Do additional shaved margins at the time of lumpectomy eliminate the need for re-excision? Am J Surg 196(4):556–558. doi:10.1016/j.amjsurg.2008.06.007
Talsma AK, Reedijk AM, Damhuis RA et al (2011) Re-resection rates after breast-conserving surgery as a performance indicator: introduction of a case-mix model to allow comparison between Dutch hospitals. Eur J Surg Oncol 37(4):357–363. doi:10.1016/j.ejso.2011.01.008
Cox CE, Ku NN, Reintgen DS et al (1991) Touch preparation cytology of breast lumpectomy margins with histologic correlation. Arch Surg 126(4):490–493
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. doi:10.1016/j.breast.2009.05.002
Moore MM, Whitney LA, Cerilli L et al (2001) Intraoperative ultrasound is associated with clear lumpectomy margins for palpable infiltrating ductal breast cancer. Ann Surg 233(6):761–768
Rahusen FD, Bremers AJ, Fabry HF et al (2002) Ultrasound-guided lumpectomy of nonpalpable breast cancer versus wire-guided resection: a randomized clinical trial. Ann Surg Oncol 9(10):994–998
Singletary SE (2002) Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg 184(5):383–393
Valdes EK, Boolbol SK, Cohen JM et al (2007) Intra-operative touch preparation cytology; does it have a role in re-excision lumpectomy? Ann Surg Oncol 14(3):1045–1050. doi:10.1245/s10434-006-9263-x
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. doi:10.1245/s10434-006-9236-0
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(6):855–861. doi:10.1016/j.jamcollsurg.2005.06.274
Cao D, Lin C, Woo SH et al (2005) Separate cavity margin sampling at the time of initial breast lumpectomy significantly reduces the need for reexcisions. Am J Surg Pathol 29(12):1625–1632
Chagpar A, Yen T, Sahin A et al (2003) Intraoperative margin assessment reduces reexcision rates in patients with ductal carcinoma in situ treated with breast-conserving surgery. Am J Surg 186(4):371–377
Chen K, Zeng Y, Jia H et al (2012) Clinical outcomes of breast-conserving surgery in patients using a modified method for cavity margin assessment. Ann Surg Oncol 19(11):3386–3394. doi:10.1245/s10434-012-2331-5
Jorns JM, Visscher D, Sabel M et al (2012) Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center. Am J Clin Pathol 138(5):657–669. doi:10.1309/ajcp4iemxcj1gdts
Olson TP, Harter J, Munoz 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. doi:10.1245/s10434-007-9437-1
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. doi:10.1245/s10434-014-3480-5
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. doi:10.1200/JCO.2013.53.3935
Bellon JR, Come SE, Gelman RS et al (2005) Sequencing of chemotherapy and radiation therapy in early-stage breast cancer: updated results of a prospective randomized trial. J Clin Oncol 23(9):1934–1940. doi:10.1200/jco.2005.04.032
Burke MF, Allison R, Tripcony L (1995) Conservative therapy of breast cancer in Queensland. Int J Radiat Oncol Biol Phys 31(2):295–303. doi:10.1016/0360-3016(94)e0210-b
Demirci S, Broadwater G, Marks LB et al (2012) Breast conservation therapy: the influence of molecular subtype and margins. Int J Radiat Oncol Biol Phys 83(3):814–820. doi:10.1016/j.ijrobp.2011.09.001
Ewertz M, Kempel MM, During M et al (2008) Breast conserving treatment in Denmark, 1989–1998. A nationwide population-based study of the Danish Breast Cancer Co-operative Group. Acta Oncol 47(4):682–690. doi:10.1080/02841860802032769
Freedman G, Fowble B, Hanlon A et al (1999) 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. Int J Radiat Oncol Biol Phys 44(5):1005–1015
Goldstein NS, Kestin L, Vicini F (2003) Factors associated with ipsilateral breast failure and distant metastases in patients with invasive breast carcinoma treated with breast-conserving therapy. A clinicopathologic study of 607 neoplasms from 583 patients. Am J Clin Pathol 120(4):500–527. doi:10.1309/8941-vdaj-mky2-gclx
Groot G, Rees H, Pahwa P et al (2011) Predicting local recurrence following breast-conserving therapy for early stage breast cancer: the significance of a narrow (</= 2 mm) surgical resection margin. J Surg Oncol 103(3):212–216. doi:10.1002/jso.21826
Horiguchi J, Koibuchi Y, Takei H et al (2002) Breast-conserving surgery following radiation therapy of 50 Gy in stages I and II carcinoma of the breast: the experience at one institute in Japan. Oncol Rep 9(5):1053–1057
Karasawa K, Mitsumori M, Yamauchi C et al (2005) Treatment outcome of breast-conserving therapy in patients with positive or close resection margins: japanese multi institute survey for radiation dose effect. Breast Cancer 12(2):91–98
Karasawa K, Obara T, Shimizu T et al (2003) Outcome of breast-conserving therapy in the Tokyo Women’s Medical University Breast Cancer Society experience. Breast Cancer 10(4):341–348
Kasumi F, Takahashi K, Nishimura S et al (2006) CIH-Tokyo experience with breast-conserving surgery without radiotherapy: 6.5 year follow-up results of 1462 patients. Breast J 12(5 Suppl 2):S181–S190. doi:10.1111/j.1075-122X.2006.00332.x
Kokubo M, Mitsumori M, Ishikura S et al (2000) Results of breast-conserving therapy for early stage breast cancer: Kyoto University experiences. Am J Clin Oncol 23(5):499–505
Kreike B, Hart AA, van de Velde T et al (2008) Continuing risk of ipsilateral breast relapse after breast-conserving therapy at long-term follow-up. Int J Radiat Oncol Biol Phys 71(4):1014–1021. doi:10.1016/j.ijrobp.2007.11.029
Kunos C, Latson L, Overmoyer B et al (2006) Breast conservation surgery achieving > or = 2 mm tumor-free margins results in decreased local-regional recurrence rates. Breast J 12(1):28–36. doi:10.1111/j.1075-122X.2006.00181.x
Liau SS, Cariati M, Noble D et al (2010) Audit of local recurrence following breast conservation surgery with 5-mm target margin and hypofractionated 40-Gray breast radiotherapy for invasive breast cancer. Ann R Coll Surg Engl 92(7):562–568. doi:10.1308/003588410x12699663903476
Livi L, Meattini I, Franceschini D et al (2013) Radiotherapy boost dose-escalation for invasive breast cancer after breast-conserving surgery: 2093 patients treated with a prospective margin-directed policy. Radiother Oncol 108(2):273–278. doi:10.1016/j.radonc.2013.02.009
Livi L, Paiar F, Saieva C et al (2007) Survival and breast relapse in 3834 patients with T1-T2 breast cancer after conserving surgery and adjuvant treatment. Radiother Oncol 82(3):287–293. doi:10.1016/j.radonc.2006.11.009
Lupe K, Truong PT, Alexander C et al (2011) Subsets of women with close or positive margins after breast-conserving surgery with high local recurrence risk despite breast plus boost radiotherapy. Int J Radiat Oncol Biol Phys 81(4):e561–e568. doi:10.1016/j.ijrobp.2011.02.021
McBain CA, Young EA, Swindell R et al (2003) Local recurrence of breast cancer following surgery and radiotherapy: incidence and outcome. Clin Oncol (R Coll Radiol) 15(1):25–31
Mirza NQ, Vlastos G, Meric F et al (2002) Predictors of locoregional recurrence among patients with early-stage breast cancer treated with breast-conserving therapy. Ann Surg Oncol 9(3):256–265
Neuschatz AC, DiPetrillo T, Safaii H et al (2003) Long-term follow-up of a prospective policy of margin-directed radiation dose escalation in breast-conserving therapy. Cancer 97(1):30–39. doi:10.1002/cncr.10981
Obedian E, Haffty BG (1999) Internal mammary nodal irradiation in conservatively-managed breast cancer patients: is there a benefit? Int J Radiat Oncol Biol Phys 44(5):997–1003
Park CC, Mitsumori M, Nixon A et al (2000) Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence. J Clin Oncol 18(8):1668–1675
Perez CA (2003) Conservation therapy in T1-T2 breast cancer: past, current issues, and future challenges and opportunities. Cancer J 9(6):442–453
Pierce LJ, Strawderman MH, Douglas KR et al (1997) Conservative surgery and radiotherapy for early-stage breast cancer using a lung density correction: the University of Michigan experience. Int J Radiat Oncol Biol Phys 39(4):921–928
Santiago RJ, Wu L, Harris E et al (2004) Fifteen-year results of breast-conserving surgery and definitive irradiation for Stage I and II breast carcinoma: the University of Pennsylvania experience. Int J Radiat Oncol Biol Phys 58(1):233–240
Smitt MC, Nowels K, Carlson RW et al (2003) Predictors of reexcision findings and recurrence after breast conservation. Int J Radiat Oncol Biol Phys 57(4):979–985
Spivack B, Khanna MM, Tafra L et al (1994) Margin status and local recurrence after breast-conserving surgery. Arch Surg 129(9):952–956 discussion 956–957
Touboul E, Buffat L, Belkacemi Y et al (1999) Local recurrences and distant metastases after breast-conserving surgery and radiation therapy for early breast cancer. Int J Radiat Oncol Biol Phys 43(1):25–38
Varghese P, Gattuso JM, Mostafa AI et al (2008) The role of radiotherapy in treating small early invasive breast cancer. Eur J Surg Oncol 34(4):369–376. doi:10.1016/j.ejso.2007.04.008
Voogd AC, Nielsen M, Peterse JL et al (2001) Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol 19(6):1688–1697
Whipp E, Beresford M, Sawyer E et al (2010) True local recurrence rate in the conserved breast after magnetic resonance imaging-targeted radiotherapy. Int J Radiat Oncol Biol Phys 76(4):984–990. doi:10.1016/j.ijrobp.2009.03.026
Acknowledgments
We would like to thank the staff members of the Department of Clinical Pathology at our hospital for their technical support.
Conflict of interest
The authors declare no conflict of interest with respect to this study.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Osako, T., Nishimura, R., Nishiyama, Y. et al. Efficacy of intraoperative entire-circumferential frozen section analysis of lumpectomy margins during breast-conserving surgery for breast cancer. Int J Clin Oncol 20, 1093–1101 (2015). https://doi.org/10.1007/s10147-015-0827-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10147-015-0827-2