Objectives: To evaluate breast lumpectomy margins by frozen section in breast conservation surgery. Methods: A retrospective study of frozen section of lumpectomy margins of one hundred ten patients was done at King Abdulaziz University Hospital from June 2007 to June 2013. All patients underwent lumpectomy + Sentinel lymph node biopsy. Patient records were studied for location of mass in breast, size of mass, site of breast, pre or postmenopausal, frozen section margins, new frozen section margins, permanent margins, reoperation. Complications like skin necrosis, numbness, and wound infection were studied. Result: Majority were Saudis (64.5%). Left breast was involved in 60%. Upper outer quadrant was involved in majority (51.9%). Size of mass was less than 1 cm in 14.8% cases, 1 - 2.9 cm in 43.5%, 3 - 4 cm in 13%, more than 4 cm in 10.2%. Lumpectomy plus sentinel lymph node biopsy was done in 96.4% and lumpectomy and axillary lymph node dissection was done in 1.8% cases. Gross margins were positive in 17.3% and frozen margins were positive in 28.2%. New margin on frozen section were positive in 3.6% and negative in 79.1%. Permanent section histology showed positive margins in 5.5% and negative in 94.5% cases. Re-operation was done in 7.3%. Lympho-vascular margins were positive in 20.9%. Skin necrosis was found in 2.2%, numbness was found in 4.4%, wound infection was in 2.2%. Conclusion: Lumpectomy margins with frozen section reduce re-operation and recurrence.
Fisher, B., Anderson, S., Bryant, J., Margolese, R.G., Deutsch, M., Fisher, E.R., et al. (2002) Twenty-Year Follow-Up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer. The New England Journal of Medicine, 347, 1233-1241. https://doi.org/10.1056/NEJMoa022152
Veronesi, U., Cascinelli, N., Mariani, L., Greco, M., Saccozzi, R., Luini, A., et al. (2002) Twenty-Year Follow-Up of a Randomized Study Comparing Breast-Conserving Surgery with Radical Mastectomy for Early Breast Cancer. The New England Journal of Medicine, 347, 1227-1232. https://doi.org/10.1056/NEJMoa020989
Mullen, R., Macaskill, E.J., Khalil, A., Elseedawy, E., Brown, D.C., Lee, A.C., et al. (2012) Involved Anterior Margins after Breast Conserving Surgery: Is Re-Excision Required? European Journal of Surgical Oncology, 38, 302-306.
Laucirica, R. (2005) Intraoperative Assessment of the Breast—Guidelines and Potential Pitfalls. Archives of Pathology & Laboratory Medicine, 129, 1565-1574.
Singletary, S.E. (2002) Surgical Margins in Patients with Early-Stage Breast Cancer Treated with Breast Conservation Therapy. The American Journal of Surgery, 184, 383-393.
Lovrics, P.J., Cornacchi, S.D., Farrokhyar, F., Garnett, A., Chen, V., Franic, S., et al. (2009) The Relationship between Surgical Factors and Margin Status after Breast Conservation Surgery for Early Stage Breast Cancer. The American Journal of Surgery, 197, 740-746.
Acosta, J.A., Greenlee, J.A., Gubler, K.D., Goepfert, C.J. and Ragland, J.J. (1995) Surgical Margins after Needle-Localization Breast Biopsy. The American Journal of Surgery, 170, 643-645.
Gajdos, C., Tartter, P.I., Bleiweiss, I.J., Hermann, G., de Csepel, J., Estabrook, A., et al. (2002) Mammographic Appearance of Nonpalpable Breast Cancer Reflects Pathologic Characteristics. Annals of Surgery, 235, 246-251. https://doi.org/10.1097/00000658-200202000-00013
Papa, M.Z., Klein, E., Davidson, B., Karni, T., Sperber, F., Koller, M., et al. (1996) The Effect of Anesthesia Type on Needle Localization Breast Biopsy: Another Point of View. The American Journal of Surgery, 171, 242-243.
McCahill, L.E., Single, R.M., Aiello Bowles, E.J., Feigelson, H.S., James, T.A., Barney, T., et al. (2012) Variability in Re-Excision Following Breast Conservation Surgery. JAMA, 307, 467-475. https://doi.org/10.1001/jama.2012.43
Freedman, G., Fowble, B., Hanlon, A., Nicolaou, N., Fein, D., Hoffman, J., et al. (1999) Patients with Early Stage Invasive Cancer with Close or Positive Margins Treated with Conservative Surgery and Radiation Have an Increased Risk of Breast Recurrence That Is Delayed by Adjuvant Systemic Therapy. International Journal of Radiation Oncology, Biology, Physics, 44, 1005-1015.
Waljee, J.F., Hu, E.S., Newman, L.A. and Alderman, A.K. (2008) Predictors of Re-Excision among Women Undergoing Breast-Conserving Surgery for Cancer. Annals of Surgical Oncology, 15, 1297-1303. https://doi.org/10.1245/s10434-007-9777-x
Veronesi, U., Cascinelli, N., Mariani, L., et al. (2002) Twenty Year Follow-Up of a Randomized Study Comparing Breast Conserving Surgery with Radical Mastectomy for Early Breast Cancer. The New England Journal of Medicine, 347, 1227-1232. https://doi.org/10.1056/NEJMoa020989
Fisher, B., Anderson, S., Bryant, J., et al. (2002) Twenty-Year Follow-Up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer. The New England Journal of Medicine, 347, 1233-1241. https://doi.org/10.1056/NEJMoa022152
Houssami, N., Macaskill, P., Marinovich, M.L., et al. (2010) Meta Analysis of the Impact of Surgical Margins on Local Recurrence in Women with Early-Stage Invasive Breast Cancer Treated with Breast-Conserving Therapy. The European Journal of Cancer, 46, 3219-3232.
Groot, G., Rees, H., Pahwa, P., Kanagaratnam, S. and Kinloch, M. (2011) Predicting Local Recurrence Following Breast-Conserving Therapy for Early Stage Breast Cancer: The Significance of a Narrow ( https://doi.org/10.1002/jso.21826
American Society of Breast Surgeons. Position Statement on Breast Cancer Lumpectomy Margins. https://www.breastsurgeons.org/statements/PDF_Statements/Lumpectomy_Margins.pdf
National Comprehensive Cancer Network. Breast Cancer (Version 1.2014). http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf
Wang, S.Y., Chu, H., Shamliyan, T., Jalal, H., Kuntz, K.M., Kane, R.L., et al. (2012) Network Meta-Analysis of Margin Threshold for Women with Ductal Carcinoma in Situ. Journal of the National Cancer Institute, 104, 507-516. https://doi.org/10.1093/jnci/djs142
Feron, J.-G., Nguyen, A., Bézu, C., Antoine, M., Darai, E., Coutant, C., Rouzier, R. and Uzan, S. (2011) Interest in Cavity Shaving in Breast Conservative Treatment Does Not Depend on Lumpectomy Technique. Breast, 20, 358-364.
Leong, C., Boyages, J., Jayasinghe, U.W., Bilous, M., Ung, O., Chua, B., et al. (2004) Effect of Margins on Ipsilateral Breast Tumor Recurrence after Breast Conservation Therapy for Lymph Node-Negative Breast Carcinoma. Cancer, 100, 1823-1832. https://doi.org/10.1002/cncr.20153
Jacobson, A.F., Asad, J., Boolbol, S.K., Osborne, M.P., Boachie-Adjei, K. and Feldman, S.M. (2008) Do Additional Shaved Margins at the Time of Lumpectomy Eliminate the Need for Re-Excision? The American Journal of Surgery, 196, 556-558.
Besana-Ciani, I. and Greenall, M.J. (2008) The Importance of Margins Status after Breast Conservative Surgery and Radiotherapy in Node Positive Patients: A Follow-Up of 10-15 Years. International Seminars in Surgical Oncology, 5, 13. https://doi.org/10.1186/1477-7800-5-13
Barthelmes, L., Al Awa, A. and Crawford, D.J. (2003) Effect of Cavity Margin Shavings to Ensure Completeness of Excision on Local Recurrence Rates Following Breast Conserving Surgery. European Journal of Surgical Oncology, 29, 644-648.
Huston, T.L., Pigalarga, R., Osborne, M.P. and Tousimis, E. (2006) The Influence of Additional Surgical Margins on the Total Specimen Volume Excised and the Re-Operative Rate after Breast-Conserving Surgery. The American Journal of Surgery, 192, 509-512.
Uecker, J.M., Bui, E.H., Foulkrod, K.H. and Sabra, J.P. (2011) Intraoperative Assessment of Breast Cancer Specimens Decreases Cost and Number of Reoperations. The American Surgeon, 77, 342-344.
O’Donnell, M.E., Salem, A., Badger, S.A., Sharif, M.A., Lioe, T. and Spence, R.A. (2008) Completion Mastectomy after Breast Conserving Surgery. Breast, 17, 199-204.
Osborn, J.B., Keeney, G.L., Jakub, J.W., Degnim, A.C. and Boughey, J.C. (2011) Cost-Effectiveness Analysis of Routine Frozen-Section Analysis of Breast Margins Compared with Reoperation for Positive Margins. Annals of Surgical Oncology, 18, 3204-3209. https://doi.org/10.1245/s10434-011-1956-0
Tengher-Barna, I., Hequet, D., Reboul-Marty, J., Frassati-Biaggi, A., Seince, N., Rodrigues-Faure, A., et al. (2008) Prevalence and Predictive Factors for the Detection of Carcinoma in Cavity Margin Performed at the Time of Breast Lumpectomy. Modern Pathology, 22, 299-305. https://doi.org/10.1038/modpathol.2008.186