Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2012

01-10-2012 | Breast Oncology

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

Authors: Karla Esbona, MS, Zhanhai Li, PhD, Lee G. Wilke, MD

Published in: Annals of Surgical Oncology | Issue 10/2012

Login to get access

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.
Literature
1.
National Institutes of Health Consensus Conference. Treatment of early-stage breast cancer. JAMA. 1991;265:391–5.CrossRef
2.
Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184:383–93.PubMedCrossRef
3.
Sabel MS. Surgical considerations in early-stage breast cancer: lessons learned and future directions. Semin Radiat Oncol. 2011;21:10–9.PubMedCrossRef
4.
Vapiwala N, Harris E, Huang WT, et al. Long-term outcome for mammographically detected ductal carcinoma in situ managed with breast conservation treatment: prognostic significance of reexcision. Cancer J. 2006;12:25–32.PubMedCrossRef
5.
Aziz D, Rawlinson E, Narod SA, et al. The role of reexcision for positive margins in optimizing local disease control after breast conserving surgery for cancer. Breast J. 2006;12:331–7.PubMedCrossRef
6.
Swanson G, Rynearson K, Symmonds R. Significance of margins of excision on breast cancer recurrence. Am J Clin Oncol. 2002;25:438–41.PubMedCrossRef
7.
Tartter PI, Kaplan J, Bleiweiss I, et al. Lumpectomy margins, reexcision and local recurrence of breast cancer. Am J Surg. 2000;179:81–5.PubMedCrossRef
8.
Wazer DE, DePetrillo T, Schmidt-Ullrich R, et al. Factors infuencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1992;10:356–63.PubMed
9.
Laucirica R. Intraoperative assessment of the breast—guidelines and potential pitfalls. Arch Pathol Lab Med. 2005;129:1565–74.PubMed
10.
Weinberg E, Cox C, Dupont E, et al. Local recurrence in lumpectomy patients after imprint cytology margin evaluation. Am J Surg. 2004;188:349–54.PubMedCrossRef
11.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9.CrossRef
12.
Ebell MH, Siwek J, Weiss BD, et al. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician. 2004;69:548–56.PubMed
13.
D’Halluin F, Tas P, Coue O, et al. Role of intraoperative imprint cytology for evaluation of surgical margins in breast cancer: a prospective controlled study about 400 lumpectomy. Virchows Arch. 2008;452:S24–5.
14.
Cabioglu N, Hunt KK, Sahin AA, et al. Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol. 2007;14:1458–71.PubMedCrossRef
15.
Camp ER, McAuliffe PF, Gilroy JS, et al. Minimizing local recurrence after breast conserving therapy using intraoperative shaved margins to determine pathologic tumor clearance. J Am Coll Surg. 2005;201:855–61.PubMedCrossRef
16.
Loibl S, von Minckwitz G, Raab G, et al. Surgical procedures after neoadjuvant chemotherapy in operable breast cancer: results of the GEPARDUO trial. Ann Surg Oncol. 2006;13:1434–42.PubMedCrossRef
17.
Valdes EK, Boolbol SK, Ali I, Feldman SM, Cohen JM. Intraoperative touch preparation cytology for margin assessment in breast-conservation surgery: does it work for lobular carcinoma? Ann Surg Oncol. 2007;14:2940–5.PubMedCrossRef
18.
Rusby JE, Paramanathan N, Laws SA, Rainsbury RM. Immediate latissimus dorsi miniflap volume replacement for partial mastectomy: use of intra-operative frozen sections to confirm negative margins. Am J Surg. 2008;196:512–8.PubMedCrossRef
19.
Fukamachi K, Ishida T, Usami S, et al. Total-circumference intraoperative frozen section analysis reduces margin-positive rate in breast-conservation surgery. Jpn J Clin Oncol. 2010;40:513–20.PubMedCrossRef
20.
Munhoz AM, Montag E, Arruda E, et al. Immediate reconstruction following breast-conserving surgery: management of the positive surgical margins and influence on secondary reconstruction. Breast. 2009;18:47–54.PubMedCrossRef
21.
Riedl O, Fitzal F, Mader N, et al. Intraoperative frozen section analysis for breast-conserving therapy in 1016 patients with breast cancer. Eur J Surg Oncol. 2009;35:264–70.PubMedCrossRef
22.
Uecker JM, Bui EH, Foulkrod KH, Sabra JP. Intraoperative assessment of breast cancer specimens decreases cost and number of reoperations. Am Surg. 2011;77:342–4.PubMed
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.PubMedCrossRef
24.
Arora S, Menes TS, Moung C, Nagi C, Bleiweiss I, Jaffer S. Atypical ductal hyperplasia at margin of breast biopsy—is re-excision indicated? Ann Surg Oncol. 2008;15:843–7.PubMedCrossRef
25.
Huston TL, Pigalarga R, Osborne MP, Tousimis E. The influence of additional surgical margins on the total specimen volume excised and the reoperative rate after breast-conserving surgery. Am J Surg. 2006;192:509–12.PubMedCrossRef
26.
Landercasper J, Ellis RL, Mathiason MA, et al. A community breast center report card determined by participation in the National Quality Measures for Breast Centers program. Breast J. 2010;16:472–80.PubMedCrossRef
27.
McCahill LE, Single R, Ratliff J, Sheehey-Jones J, Gray A, James T. Local recurrence after partial mastectomy: relation to initial surgical margins. Am J Surg. 2011;201:374–8.PubMedCrossRef
28.
Menes TS, Tartter PI, Bleiweiss I, Godbold JH, Estabrook A, Smith SR. The consequence of multiple re-excisions to obtain clear lumpectomy margins in breast cancer patients. Ann Surg Oncol. 2005;12:881–5.PubMedCrossRef
29.
Miller AR, Brandao G, Prihoda TJ, Hill C, Cruz AB, Yeh IT. Positive margins following surgical resection of breast carcinoma: analysis of pathologic correlates. J Surg Oncol. 2004;86:134–40.PubMedCrossRef
30.
Moorthy K, Asopa V, Wiggins E, Callam M. Is the reexcision rate higher if breast conservation surgery is performed by surgical trainees? Am J Surg. 2004;188:45–8.PubMedCrossRef
31.
Mullenix PS, Cuadrado DG, Steele SR, et al. Secondary operations are frequently required to complete the surgical phase of therapy in the era of breast conservation and sentinel lymph node biopsy. Am J Surg. 2004;187:643–6.PubMedCrossRef
32.
Ooi CWL, Serpell JW, Rodger A. Tumour involvement of the re-excision specimen following clear local excision of breast cancer with positive margins. ANZ J Surg. 2003;73:979–82.PubMedCrossRef
33.
O’Sullivan MJ, Li T, Freedman G, Morrow M. The effect of multiple reexcisions on the risk of local recurrence after breast conserving surgery. Ann Surg Oncol. 2007;14:3133–40.PubMedCrossRef
34.
Perez CA. Conservation therapy in T1–T2 breast cancer: past, current issues, and future challenges and opportunities. Cancer J. 2003;9:442–53.PubMedCrossRef
35.
Ramanah R, Pivot X, Sautiere JL, Maillet R, Riethmuller D. Predictors of re-excision for positive or close margins in breast-conservation therapy for pT1 tumors. Am J Surg. 2008;195:770–4.PubMedCrossRef
36.
Sanchez C, Brem RF, McSwain AR, Rapelyea JA, Torrente J, Teal CB. Factors associated with re-excision in patients with early-stage breast cancer treated with breast conservation therapy. Am Surg. 2010;76:331–4.PubMed
37.
van den Broek N, van der Sangen MJ, van de Poll-Franse LV, van Beek MW, Nieuwenhuijzen GA, Voogd AC. Margin status and the risk of local recurrence after breast-conserving treatment of lobular breast cancer. Breast Cancer Res Treat. 2007;105:63–8.PubMedCrossRef
38.
Vicini FA, Kestin LL, Goldstein NS, Baglan KL, Pettinga JE, Martinez AA. Relationship between excision volume, margin status, and tumor size with the development of local recurrence in patients with ductal carcinoma-in-situ treated with breast-conserving therapy. J Surg Oncol. 2001;76:245–54.PubMedCrossRef
39.
Barros AC, Pinotti M, Teixeira LC, Ricci MD, Pinotti JA. Outcome analysis of patients with early infiltrating breast carcinoma treated by surgery with intraoperative evaluation of surgical margins. Tumori. 2004;90:592–5.PubMed
40.
Cox CE, Hyacinthe M, Gonzalez RJ, et al. Cytologic evaluation of lumpectomy margins in patients with ductal carcinoma in situ: clinical outcome. Ann Surg Oncol. 1997;4:644–9.PubMedCrossRef
41.
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;18:248–53.PubMedCrossRef
42.
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.PubMedCrossRef
43.
Cendan JC, Coco D, Copeland EM 3rd. Accuracy of intraoperative frozen-section analysis of breast cancer lumpectomy-bed margins. J Am Coll Surg. 2005;201:194–8.PubMedCrossRef
44.
Chen WH, Cheng SP, Tzen CY, et al. Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. 2005;91:185–94.PubMedCrossRef
45.
Dener C, Inan A, Sen M, Demirci S. Interoperative frozen section for margin assessment in breast conserving energy. Scand J Surg. 2009;98:34–40.PubMed
46.
Ikeda T, Enomoto K, Wada K, et al. Frozen-section-guided breast-conserving surgery: implications of diagnosis by frozen section as a guide to determining the extent of resection. Surg Today. 1997;27:207–12.PubMedCrossRef
47.
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.PubMedCrossRef
48.
Park S, Park HS, Kim SI, Koo JS, Park BW, Lee KS. The impact of a focally positive resection margin on the local control in patients treated with breast-conserving therapy. Jpn J Clin Oncol. 2011;41:600–8.PubMedCrossRef
49.
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.PubMed
50.
Weber WP, Engelberger S, Viehl CT, et al. Accuracy of frozen section analysis versus specimen radiography during breast-conserving surgery for nonpalpable lesions. World J Surg. 2008;32:2599–606.PubMedCrossRef
Metadata
Title
Intraoperative Imprint Cytology and Frozen Section Pathology for Margin Assessment in Breast Conservation Surgery: A Systematic Review
Authors
Karla Esbona, MS
Zhanhai Li, PhD
Lee G. Wilke, MD
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 10/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2492-2

Other articles of this Issue 10/2012

Annals of Surgical Oncology 10/2012 Go to the issue

Breast Oncology

The Value of Mammography Within 1 Year of Conservative Surgery for Breast Cancer

Breast Oncology

Long-Term Results of Excision Followed by Radiofrequency Ablation as the Sole Means of Local Therapy for Breast Cancer

Breast Oncology

Surgical Delay of the Nipple–Areolar Complex: A Powerful Technique to Maximize Nipple Viability Following Nipple-Sparing Mastectomy

Breast Oncology

Comparison of Molecular Subtyping with BluePrint, MammaPrint, and TargetPrint to Local Clinical Subtyping in Breast Cancer Patients

Breast Oncology

Atypical Ductal Hyperplasia on Core Biopsy: An Automatic Trigger for Excisional Biopsy?

Breast Oncology

Patient Navigation and the Quality of Breast Cancer Care: An Analysis of the Breast Cancer Care Quality Indicators