Enter your email address
Submit
Write your message
Volume 17, Issue 3 (Iranian Journal of Breast Diseases 2024)
ijbd 2024, 17(3): 82-94 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
akbari oryani M, alizadeh mousavi F, alenabi A, forghani-tarighan M N, jabbari A, dadgar-moghadam M. Evaluation of sensitivity and specificity of intraoperative frozen section analysis of margins in patients with breast carcinoma during breast-conserving surgery and its importance in reducing the rate of re-operation. ijbd 2024; 17 (3) :82-94
URL: http://ijbd.ir/article-1-1072-en.html
URL: http://ijbd.ir/article-1-1072-en.html
Mahsa Akbari oryani *1 
, Fatemeh Alizadeh mousavi2 , Anita Alenabi3 , Mohammad naser Forghani-tarighan4 , Azadeh Jabbari4 , Maliheh Dadgar-moghadam5
, Fatemeh Alizadeh mousavi2 , Anita Alenabi3 , Mohammad naser Forghani-tarighan4 , Azadeh Jabbari4 , Maliheh Dadgar-moghadam5
1- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad. Iran , akbarimh@mums.ac.ir
2- Department of Internal Medicine, Faculty of Medicine, Mashhad university of medical sciences, Mashhad. Iran
3- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad. Iran
4- Department of Surgery, Faculty of Medicine, Mashhad university of medical sciences, Mashhad. Iran
5- Research deputy of School of medicine, Head of Community Medicine Department, Associate professor
2- Department of Internal Medicine, Faculty of Medicine, Mashhad university of medical sciences, Mashhad. Iran
3- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad. Iran
4- Department of Surgery, Faculty of Medicine, Mashhad university of medical sciences, Mashhad. Iran
5- Research deputy of School of medicine, Head of Community Medicine Department, Associate professor
Abstract: (420 Views)
Introduction: Intra-operative frozen section analysis (IOFSA) during breast-conserving surgery (BCS) is recommended to reduce the need for reoperation and its complications. The present study aimed to assess the sensitivity and specificity of IOFSA to determine the margin in specimens of breast cancer lumpectomy during BCS in patients with invasive and in situ breast carcinoma.
Methods: We performed IOFSA during breast-conserving surgery for 151 patients with breast cancer and a positive margin was defined as tumor cells (either invasive or in situ carcinoma) extended to the inked margin or extended to within 2 mm of the inked margin. The results of frozen sections (margin status) were reported to the surgeon. Then tissue was fixed and embedded in paraffin for definitive histological analysis and future comparison.
Results: The obtained results indicated that sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the frozen section were 96.42%, 94.73%, 91.52%, 97.82%, and 95.36%, respectively.
Conclusion: As evidenced by the results of this study, the use of IOFSA during breast-conserving surgery could lead to a 5-fold reduction in the need for reoperation and risk of reoperation complications, such as anesthesia and cosmetic complications, as well as psychological and financial burdens.
Methods: We performed IOFSA during breast-conserving surgery for 151 patients with breast cancer and a positive margin was defined as tumor cells (either invasive or in situ carcinoma) extended to the inked margin or extended to within 2 mm of the inked margin. The results of frozen sections (margin status) were reported to the surgeon. Then tissue was fixed and embedded in paraffin for definitive histological analysis and future comparison.
Results: The obtained results indicated that sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the frozen section were 96.42%, 94.73%, 91.52%, 97.82%, and 95.36%, respectively.
Conclusion: As evidenced by the results of this study, the use of IOFSA during breast-conserving surgery could lead to a 5-fold reduction in the need for reoperation and risk of reoperation complications, such as anesthesia and cosmetic complications, as well as psychological and financial burdens.
Type of Study: Research |
Subject:
Diagnosis, treatment, rehabilitation
Received: 2023/10/24 | Accepted: 2024/08/30 | Published: 2024/10/6
Received: 2023/10/24 | Accepted: 2024/08/30 | Published: 2024/10/6
References
1. DeSantis CE, Ma J, Goding Sauer A, Newman LA, Jemal A. Breast cancer statistics, 2017, racial disparity in mortality by state. CA Cancer J Clin. 2017 Nov; 67(6):439-48. doi: 10.3322/caac.21412. [DOI:10.3322/caac.21412]
2. Haghighat S, Omidi Z, Ghanbari-Motlagh A. Trend of breast cancer incidence in Iran during a fifteen-year interval according to national cancer registry reports. Iranian Journal of Breast Diseases. 2022;15(2):4-17. [DOI:10.30699/ijbd.15.2.4]
3. Mousavi SM, Montazeri A, Mohagheghi MA, Jarrahi AM, Harirchi I, Najafi M, et al. Breast cancer in Iran: an epidemiological review. The breast journal. 2007;13(4):383-91. [DOI:10.1111/j.1524-4741.2007.00446.x]
4. Schwartz AM, Henson DE, Chen D, Rajamarthandan S. Histologic grade remains a prognostic factor for breast cancer regardless of the number of positive lymph nodes and tumor size: a study of 161 708 cases of breast cancer from the SEER Program. Archives of Pathology and Laboratory Medicine. 2014;138(8):1048-52. [DOI:10.5858/arpa.2013-0435-OA]
5. Jaroensri R, Wulczyn E, Hegde N, Brown T, Flament-Auvigne I, Tan F, et al. Deep learning models for histologic grading of breast cancer and association with disease prognosis. NPJ Breast cancer. 2022;8(1): 113. [DOI:10.1038/s41523-022-00478-y]
6. Rakha EA, Tse GM, Quinn CM. An update on the pathological classification of breast cancer. Histopathology. 2023;82(1):5-16. [DOI:10.1111/his.14786]
7. Wu MH, Chou YC, Yu JC, Yu CP, Wu CC, Chu CM, et al. Hormonal and body-size factors in relation to breast cancer risk: a prospective study of 11,889 women in a low-incidence area. Ann Epidemiol. 2006;16(3):223-9. doi: 10.1016/j. annepidem.2005.02.015. [DOI:10.1016/j.annepidem.2005.02.015]
8. Johns N, Dixon JM. Should patients with early breast cancer still be offered the choice of breast conserving surgery or mastectomy?. European journal of surgical oncology (EJSO). 2016;42(11):1636-41. [DOI:10.1016/j.ejso.2016.08.016]
9. Chen K, Liu J, Zhu L, Su F, Song E, Jacobs LK. Comparative effectiveness study of breast-conserving surgery and mastectomy in the general population: a NCDB analysis. Oncotarget. 2015;6(37):40127. [DOI:10.18632/oncotarget.5394]
10. Nguyen J, Le QH, Duong BH, Sun P, Pham HT, Ta VT, et al. A matched case‐control study of risk factors for breast cancer risk in Vietnam. International journal of breast cancer. 2016;2016(1):7164623. [DOI:10.1155/2016/7164623]
11. Van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. Cancer/Radiothérapie. 2001;2(5):211-2. [DOI:10.1016/S1278-3218(00)00082-2]
12. Nguyen J, Le QH, Duong BH, Sun P, Pham HT, Ta VT, et al. A matched case‐control study of risk factors for breast cancer risk in Vietnam. International journal of breast cancer. 2016;2016(1): 7164623. [DOI:10.1155/2016/7164623]
13. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. New England Journal of Medicine. 2002;347 (16):1233-41. [DOI:10.1056/NEJMoa022152]
14. Early Breast Cancer Trialists' Collaborative Group. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. The Lancet. 2011;378(9804):1707-16. [DOI:10.1016/S0140-6736(11)61629-2]
15. Jacobson JA, Danforth DN, Cowan KH, d'Angelo T, Steinberg SM, Pierce L, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. New England Journal of Medicine. 1995; 332(14):907-11. [DOI:10.1056/NEJM199504063321402]
16. Leong C, Boyages J, Jayasinghe UW, Bilous M, Ung O, Chua B, et al. Effect of margins on ipsilateral breast tumor recurrence after breast conservation therapy for lymph node‐negative breast carcinoma. Cancer: Interdisciplinary International Journal of the American Cancer Society. 2004;100(9):1823-32. [DOI:10.1002/cncr.20153]
17. Aziz D, Rawlinson E, Narod SA, Sun P, Lickley HL, McCready DR, et al. The role of reexcision for positive margins in optimizing local disease control after breast‐conserving surgery for cancer. The breast journal. 2006;12(4):331-7. [DOI:10.1111/j.1075-122X.2006.00271.x]
18. Talsma AK, Reedijk AM, Damhuis RA, Westenend PJ, Vles WJ. Re-resection rates after breast-conserving surgery as a performance indicator: introduction of a case-mix model to allow comparison between Dutch hospitals. European Journal of Surgical Oncology. 2011;37(4):357-63. [DOI:10.1016/j.ejso.2011.01.008]
19. Jacobson AF, Asad J, Boolbol SK, Osborne MP, Boachie-Adjei K, Feldman SM. Do additional shaved margins at the time of lumpectomy eliminate the need for re-excision?. The American journal of surgery. 2008;196(4):556-8. [DOI:10.1016/j.amjsurg.2008.06.007]
20. Ko S, Chun YK, Kang SS, Hur MH. The usefulness of intraoperative circumferential frozen-section analysis of lumpectomy margins in breast-conserving surgery. Journal of breast cancer. 2017;20(2):176-82. [DOI:10.4048/jbc.2017.20.2.176]
21. Yavari P, Mosavizadeh MA, Khodabakhshi R, Madani H, Mehrabi Y. Reproductive characteristics and the risk of breast cancer: a case-control study. Iranian Journal of Epidemiology. 2006;1(3):11-9.
22. Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. The American journal of surgery. 2002;184(5):383-93. [DOI:10.1016/S0002-9610(02)01012-7]
23. Smitt MC, Nowels K, Carlson RW, Jeffrey SS. Predictors of reexcision findings and recurrence after breast conservation. International Journal of Radiation Oncology Biology Physics. 2003;57(4):979-85. [DOI:10.1016/S0360-3016(03)00740-5]
24. Keskek M, Kothari M, Ardehali B, Betambeau N, Nasiri N, Gui GP. Factors predisposing to cavity margin positivity following conservation surgery for breast cancer. European Journal of Surgical Oncology (EJSO). 2004;30(10): 1058-64. [DOI:10.1016/j.ejso.2004.07.019]
25. Scopa CD, Aroukatos P, Tsamandas AC, Aletra C. Evaluation of margin status in lumpectomy specimens and residual breast carcinoma. The Breast Journal. 2006;12(2): 150-3. [DOI:10.1111/j.1075-122X.2006.00223.x]
26. Sauter ER, Hoffman JP, Ottery FD, Kowalyshyn MJ, Litwin S, Eisenberg BL. Is frozen section analysis of reexcision lumpectomy margins worthwhile? Margin analysis in breast reexcisions. Cancer. 1994;73(10):2607-12.
https://doi.org/10.1002/1097-0142(19940515)73:10<2607::AID-CNCR2820731023>3.0.CO;2-1 [DOI:10.1002/1097-0142(19940515)73:103.0.CO;2-1]
27. Dener C, Inan A, Sen M, Demirci S. Intraoperative frozen section for margin assessment in breast conserving surgery. Scandinavian Journal of Surgery. 2009;98 (1):34-40. [DOI:10.1177/145749690909800107]
28. Nowikiewicz T, Śrutek E, Głowacka-Mrotek I, Tarkowska M, Żyromska A, Zegarski W. Clinical outcomes of an intraoperative surgical margin assessment using the fresh frozen section method in patients with invasive breast cancer undergoing breast-conserving surgery-a single center analysis. Scientific reports. 2019;9(1):13441. [DOI:10.1038/s41598-019-49951-y]
29. Karve PV, Jambhekar NA, Desai SS, Chinoy RF. Role of frozen section evaluation in patients with breast lumps: A study of 251 cases. Indian J Surg. 2005 ;67(5):241-5.
30. Fukamachi K, Ishida T, Usami S, Takeda M, Watanabe M, Sasano H, et al. Total-circumference intraoperative frozen section analysis reduces margin-positive rate in breast-conservation surgery. Japanese journal of clinical oncology. 2010;40(6): 513-20. [DOI:10.1093/jjco/hyq006]
31. Torp SH, Skjørten FJ. The reliability of frozen section diagnosis. Acta chirurgica scandinavica. 1990;156(2):127-30.
32. Ko S, Chun YK, Kang SS, Hur MH. The usefulness of intraoperative circumferential frozen-section analysis of lumpectomy margins in breast-conserving surgery. Journal of breast cancer. 2017;20(2):176-82. [DOI:10.4048/jbc.2017.20.2.176]
33. Jorns JM, Visscher D, Sabel M, Breslin T, Healy P, Daignaut S, et al. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center. American journal of clinical pathology. 2012;138(5): 657-69. [DOI:10.1309/AJCP4IEMXCJ1GDTS]
34. Boughey JC, Keeney GL, Radensky P, Song CP, Habermann EB. Economic implications of widespread expansion of frozen section margin analysis to guide surgical resection in women with breast cancer undergoing breast-conserving surgery. Journal of oncology practice. 2016;12(4):e413-22. [DOI:10.1200/JOP.2015.005652]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
