[183] Intraoperative Frozen Section Analysis of Margins in Breast Conserving Surgeries Significantly Decreases Re-Operative Rates: One Year Experience at an Outpatient Surgery Center.

Julie Jorns, Daniel Visscher, Michael Sabel, Tara Breslin, Alfred Chang, Stephanie Daignaut-Newton, Jeffrey Myers, Angela Wu. University of Michigan, Ann Arbor

Background: Intraoperative frozen section (FS) analysis to achieve negative margins is not routinely performed in patients undergoing breast conserving therapy (BCT), resulting in re-operation rates ranging from 32-63%. This abstract outlines the development of a FS practice in this population at a single outpatient surgical center.
Design: Study patients (S) receiving BCT ± sentinel lymph node biopsy (SLNB) with FS (N=181) over one year and Controls (C) who underwent the same procedures at the same center in the year prior to FS capability (N=188) were compared. For FS analysis of margins (FSM) in BCT, grossly suspicious margins were sampled, frozen in liquid nitrogen, and cut on a standard cryostat. FS of SLNB (FS SLNB) included sectioning and submission of the entire SLN. Re-excision of positive/close margins was performed and sometimes submitted for FS. Completion axillary lymph node dissections (cALND) were performed following positive SLNB. Factors reviewed were age, imaging, tumor type, grade, size, co-existent DCIS, multifocality, #blocks frozen, #close/positive margins, #re-excisions, and reasons for re-operation.
Results: Average turn-around-time was 23.6 min/case. An average of 6 blocks/lumpectomy was frozen. Only 35 (19.4%) patients who had FSM ± FS SLNB required re-operation compared to 104 (55.3%) without FS, with a statistically significant decrease in patients requiring multiple surgeries to complete therapy.

#Surgeries Required to Complete Therapy
 StudyControl
1145 (80.6%)84 (44.7%)
233 (18.3%)92 (48.9%)
32 (1.1%)12 (6.4%)


Indications for additional surgeries included re-excision lumpectomy/mastectomy and cALND for 33 and 5 patients in the S group and 102 and 21 patients in the C group. SLNB (11) was also an indication for re-operation in the C group. Half of intraoperative false negative (FN) margin results were influenced by close/positive margins in re-excised specimens (based on initial FS results) sent only for permanent section. Statistically significant factors associated with FN margins included lobular subtype, multifocality and extensive DCIS. FS SLNB (N=182) showed 147 (80.8%) TN, 32 (17.6%) TP, and 3 (1.6%) FN results. SLNB FNs were due to sampling (2) and interpretation (1) error.
Conclusions: FSM can be performed rapidly and effectively in an outpatient setting for patients undergoing BCT, providing significant reduction in re-operation rates.
Category: Breast

Monday, February 28, 2011 9:00 AM

Platform Session: Section C, Monday Morning

 

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