Intraoperative Margin Assessment Significantly Improves Quality of Care in Patients Undergoing Breast Conserving Surgery
Soma G Karak, Lavinia P Middleton, Min Yi, Kelly K Hunt, Aysegul A Sahin. University of Texas MD Anderson Cancer Center, Houston, TX
Background: The goal of treating breast cancer patients with breast conserving therapy (BCS) is to obtain negative margins, as positive margins are associated with local/regional recurrence. BCS aims to achieve a balance between complete resection of the tumor with negative margins and avoiding excessive resection of non-neoplastic breast tissue to provide favorable cosmesis for the patient. The reported rate of re-excision for margin control after BCS is 48-59%. We investigated the relevance of intra-operative assessment of breast specimens in this era of improved mammographic techniques.
Design: In the six month period of January to June 2010, 315 patients underwent BCS under needle localization 164 (52%), ultrasound guidance (39%), or other 8 (9%) techniques with intraoperative margin analysis to include gross examination, sliced specimen radiography, with or without frozen section.
Results: 211 (67%) patients with invasive ductal carcinoma (IDC), 81 (26%) patients with ductal carcinoma in situ (DCIS), 17 (5%) patients with invasive lobular carcinoma (ILC) and 6 (2 %) with other pathology were excised. Median age 57 (range 25 to 89) 50 patients (15.87%) received pre-operative chemotherapy. 138 (43%) patients were evaluated and found to have negative margins during intraoperative examination. 112 of these patients had true negative margins after final pathologic evaluation (81.15%). Negative predictive value 81.5%, positive predictive value 75.14%. 13 patients had positive or close margins identified in frozen section and had true positive margins after final histologic evaluation (100%). 164 patients had positive or close margins determined intraoperatively. 26 cases (8.25%) showed discordance with intraoperative assessment of negative margins and positive final margins. Half of the discordant cases (13) were patients with DCIS, 30.8% (8) were patients with IDC and DCIS, and the remaining 5 (19.2%) were cases of IDC.
Conclusions: Intraoperative assessment of margins assisted in identifying positive/close margins and allowed greater than 90% of the patients to obtain negative margins with re-excision during the initial operation. Despite advances in radiologic techniques, the role for intraoperative assessment remains necessary. Intraoperative multidisciplinary margin evaluation is a value added component in the management of patients with breast cancer and can reduce the need for additional surgery by 40%.
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 25, Tuesday Morning