Intraoperative Frozen Section Analysis of Margins in Breast Cancer.
Masako Kasami, Takayoshi Uematsu, Chiho Sugiyama. Shizuoka Cancer Center Hospital and Research Institute, Nagaizumi, Shizuoka, Japan
Background: Accurate intraoperative examination of surgical margins and lymph nodes is important in order to reduce the need for additional surgery. The objective of the current study is to determine the accuracy of the intraoperative margins on frozen sections (MFS) and lymph nodes (LFS).
Design: The authors retrospectively reviewed the records of 765 patients with MFS analysis and 893 patients with LFS analysis during breast cancer surgery, and 695 patients without analysis of MFS. Records were taken from a single institution from September 2002 through August 2007. We compared the final margin status between cases with MFS (at least one block) and cases without MFS by permanent serial sections of surgical specimen (SUR). We were also compared residual malignancy in additional resection because of positive SUR (51 cases), local recurrence with or without radiation, distant metastasis and prognosis between cases with positive margins (<2mm or 2-5mm) and those with negative margins. The mean follow up periods was 5.6 years.
Results: The accuracy of LFS was 97%, however, the accuracy of MFS was much lower. Negative margins by MFS turned out positive by SUR in 101 out of 609 (17%) and positive margins by MFS were also positive in 39 out of 89 (44%) after additional intraoperative resections. Overall positive rate was 20%.For cases without MFS, 49 out of 149 (33%) cases showed positive margins. Margin status was statistically better in cases with MFS than in those without MFS (p<0.0001). Residual malignancy was found in 23 out of 41 cases (45%) with positive margins of less than 2mm, and in 4 out of 10 cases (40%) with positive margins of 2-5mm on SUR. Only 3 out of 14 cases of local recurrence had positive margins on SUR.