Skip to main content

Advertisement

SpringerLink
Log in

Effect of Intraoperative Imprint Cytology Followed by Frozen Section on Margin Assessment in Breast-Conserving Surgery

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

Abstract

Purpose

Intraoperative margin assessment can reduce positive margins in patients undergoing breast-conserving surgery. However, reports on intraoperative margin assessment have described only the use of either imprint cytology or frozen section. This study was designed to elucidate the effect of intraoperative margin assessment using imprint cytology followed by frozen section.

Methods

Overall, 522 patients were enrolled. First, the entire surgical margin was subjected to imprint cytology. Frozen section was performed only in cases with “positive” or “suspicious” imprint cytology results. An additional intraoperative excision was performed in patients with frozen section-positive lesion sites. All margins were evaluated using postoperative permanent sections after excision.

Results

Among 522 patients, 136 (26.1%) were imprint cytology-positive, and 386 (73.9%) were imprint cytology-negative. Among the 386 imprint cytology-negative patients not subjected to frozen section, 11 (2.1%) were permanent sections-positive (imprint cytology-false-negative). In 47 of the 136 imprint cytology-positive patients, additional intraoperative excision was unnecessary due to the frozen section-negative diagnosis. Moreover, these patients could avoid reoperation, because they were permanent section-negative. The false-positive rate of imprint cytology alone was 13.4%, but adding frozen section to imprint cytology decreased the overall false-positive rate to 2.5%. After undergoing excision, four patients still had positive margins. The overall positive margin rate in the final pathology based on permanent sections was 2.9% (15/522).

Conclusions

Imprint cytology followed by frozen section led to a markedly decreased positive margin rate. This is considered the best method for intraoperative margin assessment, as it can overcome the limitations of cytology and histology performed individually.

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

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Valdes EK, Boolbol SK, Cohen JM, Feldman SM. Intra-operative touch preparation cytology; does it have a role in re-excision lumpectomy? Ann Surg Oncol. 2007;14:1045–50.

    Article  Google Scholar 

  2. Park CC, Mitsumori M, Nixon A, et al. 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. 2000;18:1668–75.

    Article  CAS  Google Scholar 

  3. Olson TP, Harter J, Muñoz A, Mahvi DM, Breslin T. Frozen section analysis for intraoperative margin assessment during breast-conserving surgery results in low rates of re-excision and local recurrence. Ann Surg Oncol. 2007;14:2953–60.

    Article  CAS  Google Scholar 

  4. Eggemann H, Ignatov T, Costa SD, Ignatov A. Accuracy of ultrasound-guided breast-conserving surgery in the determination of adequate surgical margins. Breast Cancer Res Treat. 2014. https://doi.org/10.1007/s10549-014-2932-8.

    Article  PubMed  Google Scholar 

  5. Laws A, Brar MS, Bouchard-Fortier A, Leong B, Quan ML. Intraoperative margin assessment in wire-localized breast-conserving surgery for invasive cancer: a population-level comparison of techniques. Ann Surg Oncol. 2016. https://doi.org/10.1245/s10434-016-5401-2.

    Article  PubMed  Google Scholar 

  6. Moore MM, Whitney LA, Cerilli L, et al. Intraoperative ultrasound is associated with clear lumpectomy margins for palpable infiltrating ductal breast cancer. Ann Surg. 2001;233:761–8.

    Article  CAS  Google Scholar 

  7. VanderVelde J, Walters JW, Hsu CH, et al. Awareness of residents’ technical ability can affect margin status in breast conserving operations. Breast Cancer Res Treat. 2019 https://doi.org/10.1007/s10549-019-05344-3.

    Article  Google Scholar 

  8. Weber S, Storm FK, Stitt J, Mahvi DM. The role of frozen section analysis of margins during breast conservation surgery. Cancer J Sci Am. 1997;3:273–7.

    CAS  PubMed  Google Scholar 

  9. Klimberg VS, Westbrook KC, Korourian S. Use of touch preps for diagnosis and evaluation of surgical margins in breast cancer. Ann Surg Oncol. 1998;5:220–6.

    Article  CAS  Google Scholar 

  10. D’Halluin F, Tas P, Rouquette S, et al. Intra-operative touch preparation cytology following lumpectomy for breast cancer: a series of 400 procedures. Breast. 2009. https://doi.org/10.1016/j.breast.2009.05.002.

    Article  PubMed  Google Scholar 

  11. St John ER, Al-Khudairi R, Ashrafian H, et al. Diagnostic accuracy of intraoperative techniques for margin assessment in breast cancer surgery: a meta-analysis. Ann Surg. 2017. https://doi.org/10.1097/SLA.0000000000001897.

    Article  PubMed  Google Scholar 

  12. Akaike G, Tsunoda H, Hayashi N, et al. Ultrasonography mapping combined with mammography before breast-conserving surgery for primary breast cancer with microcalcifications: a novel approach. Clin Breast Cancer. 2014;14:352–7.

    Article  Google Scholar 

  13. Moran MS, Schnitt SJ, Giuliano AE, et al. 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. 2014. https://doi.org/10.1200/JCO.2013.53.3935.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gray RJ, Pockaj BA, Garvey E, Blair S. Intraoperative margin management in breast-conserving surgery: a systematic review of the literature. Ann Surg Oncol. 2018. https://doi.org/10.1245/s10434-016-5756-4.

    Article  PubMed  Google Scholar 

  15. Esbona K, Li Z, Wilke LG. Intraoperative imprint cytology and frozen section pathology for margin assessment in breast conservation surgery: a systematic review. Ann Surg Oncol. 2012. https://doi.org/10.1245/s10434-012-2492-2.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cox CE, Ku NN, Reintgen DS, Greenberg HM, Nicosia SV, Wangensteen S. Touch preparation cytology of breast lumpectomy margins with histologic correlation. Arch Surg. 1991;126:490–3.

    Article  CAS  Google Scholar 

  17. Klimberg VS, Harms S, Korourian S. Assessing margin status. Surg Oncol. 1999;8:77–84.

    Article  CAS  Google Scholar 

  18. Sumiyoshi K, Nohara T, Iwamoto M, et al. Usefulness of intraoperative touch smear cytology in breast-conserving surgery. Exp Ther Med. 2010;1:641–5.

    Article  Google Scholar 

  19. 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. 2015. https://doi.org/10.1007/s10147-015-0827-2.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Laucirica R. Intraoperative assessment of the breast: guidelines and potential pitfalls. Arch Pathol Lab Med. 2005;129:1565–74.

    Article  Google Scholar 

  21. Ko S, Chun YK, Kang SS, Hur MH. The usefulness of intraoperative circumferential frozen-section analysis of lumpectomy margins in breast-conserving surgery. J Breast Cancer. 2017. https://doi.org/10.4048/jbc.2017.20.2.176.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Boughey JC, Hieken TJ, Jakub JW, et al. Impact of analysis of frozen-section margin on reoperation rates in women undergoing lumpectomy for breast cancer: evaluation of the National Surgical Quality Improvement Program data. Surgery. 2014;156:190–7.

    Article  Google Scholar 

  23. Osborn JB, Keeney GL, Jakub JW, Degnim AC, Boughey JC. Cost-effectiveness analysis of routine frozen-section analysis of breast margins compared with reoperation for positive margins. Ann Surg Oncol. 2011;18:3204–9.

    Article  Google Scholar 

  24. Adam M Zysk, Kai Chen, Edward Gabrielson, et al. 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. 2015;22:3356–62.

  25. Schnabel F, Boolbol SK, Gittleman M, et al. A randomized prospective study of lumpectomy margin assessment with use of margin probe in patients with nonpalpable breast malignancies. Ann Surg Oncol. 2014;21:1589–95.

    Article  Google Scholar 

  26. Hutson SW, Cowen PN, Bird CC. Morphometric studies of age related changes in normal human breast and their significance for evolution of mammary cancer. J Clin Pathol. 1985;38:281–7.

    Article  CAS  Google Scholar 

  27. Creager AJ, Shaw JA, Young PR, Geisinger KR. Intraoperative evaluation of lumpectomy margins by imprint cytology with histologic correlation: a community hospital experience. Arch Pathol Lab Med. 2002;126:846–8.

    Article  Google Scholar 

  28. Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184:383–93.

    Article  Google Scholar 

  29. Sneige N, Staerkel GA. Fine-needle aspiration cytology of ductal hyperplasia with and without atypia and ductal carcinoma in situ. Hum Pathol. 1994;25:485–92.

    Article  CAS  Google Scholar 

  30. Julie Mook, Rebecca Klein, Anne Kobbermann, et al. Volume of excision and cosmesis with routine cavity shave margins technique. 2012;19:886–91.

Download references

Acknowledgments

The authors thank all the staff from the departments of Breast Surgical Oncology and Pathology, Funabashi Municipal Medical Center, for their help in collecting the clinical data.

Author information

Authors and Affiliations

  1. Department of Breast Surgical Oncology, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan

    Tamaki Tamanuki MD, Maki Namura MD, Tomoyoshi Aoyagi MD & Hiroshi Matsuzaki MD

  2. Department of Pathology, Funabashi Municipal Medical Center, Funabashi, Chiba, Japan

    Sinichirou Shimizu MD & Tomoko Suwa MT

Authors
  1. Tamaki Tamanuki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maki Namura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomoyoshi Aoyagi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sinichirou Shimizu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomoko Suwa MT
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroshi Matsuzaki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tamaki Tamanuki MD.

Ethics declarations

Disclosure

The authors have nothing to disclose regarding commercial support.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tamanuki, T., Namura, M., Aoyagi, T. et al. Effect of Intraoperative Imprint Cytology Followed by Frozen Section on Margin Assessment in Breast-Conserving Surgery. Ann Surg Oncol 28, 1338–1346 (2021). https://doi.org/10.1245/s10434-020-08955-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-08955-z

Search

Navigation