Main Article Content
Breast Carcinoma, Breast-Conserving Surgery, Positive Surgical Margin
Background: Breast cancer is the second most common cancer in women. Breast-conserving surgery (BCS) has increasingly been applied to eligible patients. One of the most important points in BCS is to provide clean surgical margins. In this study, it is aimed to share the re-excision results of those having positive surgical margins in intra-operative evaluation among BCS patients, and to discuss the intra-operative evaluation in the light of the literature.
MATERIALS AND METHODS:The data (patient files, surgery notes and pathology reports) of 203 patients who had undergone BCS for breast cancer between January 2016 and January 2022 and whose excision materials had been evaluated with intra-operative frozen sections in terms of surgical margins, were scanned retrospectively. Absence of ink on tumoral cells (“no ink on tumor”) for invasive ductal carcinoma (IDC), and a margin width of ≥ 2mm for ductal carcinoma in situ (DCIS) were considered as a clean surgical margin.
RESULTS: Median age was 51 years (range, 22-75). There were reportedly 27 with positive surgical margins, five of whom with positive margins in re-excision. Second re-excision specimens of all these 5 cases (18.5%) had been reported to have no positive surgical margins. No patients had been reported to require a second re-excision or mastectomy.
CONCLUSION: Intraoperative surgical margin assessment eliminates the need for repetitive surgery. We recommend routine application of intra-operative surgical margin assessment.
2. Zavagno G, Goldin E, Mencarelli R, Capitanio G, Del Bianco P, Marconato R, et al. Role of resection margins in patients treated with breast conservation surgery. Cancer. 2008 May 1;112(9):1923-31. doi: 10.1002/cncr.23383.
3. McCahill LE, Single RM, Aiello Bowles EJ, Feigelson HS, James TA, Barney T, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012 Feb 1;307(5):467-75. doi: 10.1001/jama.2012.43.
4. Metcalfe LN, Zysk AM, Yemul KS, Jacobs LK, Oker EE, Underwood HR, et al. Beyond the Margins-Economic Costs and Complications Associated With Repeated Breast-Conserving Surgeries. JAMA Surg. 2017 Nov 1;152(11):1084-1086. doi: 10.1001/jamasurg.2017.2661.
5. Schwarz J, Schmidt H. Technology for Intraoperative Margin Assessment in Breast Cancer. Ann Surg Oncol. 2020 Jul;27(7):2278-2287. doi: 10.1245/s10434-020-08483-w.
6. Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014 Mar;21(3):717-30. doi: 10.1245/s10434-014-3480-5.
7. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):553-64. doi: 10.1016/j.ijrobp.2013.11.012.
8. Pilewskie M, Morrow M. Margins in breast cancer: How much is enough? Cancer. 2018 Apr 1;124(7):1335-1341. doi: 10.1002/cncr.31221.
9. Esbona K, Li Z, Wilke LG. Intraoperative imprint cytology and frozen section pathology for margin assessment in breast conservation surgery: a systematic review. Ann Surg Oncol. 2012 Oct;19(10):3236-45. doi: 10.1245/s10434-012-2492-2.
10. Reid VJ, Falk JS, Police AM, Ridgeway CA, Cadena LL, Povoski SP. Minimizing re-excision after breast conserving surgery - a review of radiofrequency spectroscopy for real-time, intraoperative margin assessment. Expert Rev Med Devices. 2021 Nov;18(11):1057-1068. doi: 10.1080/17434440.2021.1992273.
11. Valero MG, Mallory MA, Losk K, Tukenmez M, Hwang J, Camuso K, et al. Surgeon Variability and Factors Predicting for Reoperation Following Breast-Conserving Surgery. Ann Surg Oncol. 2018 Sep;25(9):2573-2578. doi: 10.1245/s10434-018-6526-2.
12. Koca B, Kuru B, Yuruker S, Gokgul B, Ozen N. Factors affecting surgical margin positivity in invasive ductal breast cancer patients who underwent breast-conserving surgery after preoperative core biopsy diagnosis. J Korean Surg Soc. 2013 Mar;84(3):154-9. doi: 10.4174/jkss.2013.84.3.154.
13. Devane LA, Baban CK, O'Doherty A, Quinn C, McDermott EW, Prichard RS. The Impact of Neoadjuvant Chemotherapy on Margin Re-excision in Breast-Conserving Surgery. World J Surg. 2020 May;44(5):1547-1551. doi: 10.1007/s00268-020-05383-8.
14. Lanahan CR, Kelly BN, Gadd MA, Specht MC, Brown CL, Hughes KS, et al. Performance of a novel protease-activated fluorescent imaging system for intraoperative detection of residual breast cancer during breast conserving surgery. Breast Cancer Res Treat. 2021 May;187(1):145-153. doi: 10.1007/s10549-021-06106-w.
15. Melnik I, Lifshitz I, Weinshtein P, Yoffe B. [Intraoperative margin evaluation in breast-conservation surgery using margin probe technique]. Harefuah. 2014 Jan;153(1):12-4, 66, 65. Hebrew. PMID: 24605399.
16. Racz JM, Glasgow AE, Keeney GL, Degnim AC, Hieken TJ, Jakub JW, et al. Intraoperative Pathologic Margin Analysis and Re-Excision to Minimize Reoperation for Patients Undergoing Breast-Conserving Surgery. Ann Surg Oncol. 2020 Dec;27(13):5303-5311. doi: 10.1245/s10434-020-08785-z.
17. Chagpar A, Yen T, Sahin A, Hunt KK, Whitman GJ, Ames FC, et al. Intraoperative margin assessment reduces reexcision rates in patients with ductal carcinoma in situ treated with breast-conserving surgery. Am J Surg. 2003 Oct;186(4):371-7. doi: 10.1016/s0002-9610(03)00264-2.
Article Statistics :Views : 69 | Downloads : 35 : 0