Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: One-year experience at an ambulatory surgical center

Julie M. Jorns, Daniel W Visscher, Michael Sabel, Tara Breslin, Patrick Healy, Stephanie Daignaut, Jeffrey L. Myers, Angela J. Wu

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Intraoperative frozen section (FS) margin evaluation is not common practice for patients undergoing breast conservation therapy (BCT), but offers a significant reduction in reoperation. In this study, a technique to allow for more effective freezing of breast tissue was developed to perform FS evaluation of lumpectomy margins (FSM) for all patients undergoing BCT at an ambulatory surgery center. FS evaluation of sentinel lymph node biopsy specimens was performed concurrently. One hundred eighty-one study and 188 control patients, with and without FS evaluation, were compared. Reexcision was reduced 34% (from 48.9% to 14.9%) and reoperation was reduced 36% (from 55.3% to 19.3%) with FS evaluation. Most of the decrease in reoperative rate was because of a decrease in the need for margin reexcision. The number of patients requiring 1, 2, or 3 operations to complete therapy was 84, 92, and 12, respectively, in the control group, and 146, 33, and 2, respectively, in the study group. Lobular subtype, multifocal disease, and larger tumor size (≥2 cm) were significantly associated with failure of FSM to prevent reoperation, but reoperation rates were still significantly decreased in this subgroup of patients (from 75.5% to 43.8%) with FSM. This study highlights an innovative yet simple and adaptable FS approach that resulted in a nearly 3-fold reduction in reoperation for patients undergoing BCT.

Original languageEnglish (US)
Pages (from-to)657-669
Number of pages13
JournalAmerican Journal of Clinical Pathology
Volume138
Issue number5
DOIs
StatePublished - Nov 2012

Fingerprint

Segmental Mastectomy
Frozen Sections
Reoperation
Sentinel Lymph Node Biopsy
Ambulatory Surgical Procedures
Freezing
Breast
Control Groups
Neoplasms

Keywords

  • Breast conservation therapy
  • Frozen section
  • Intraoperative frozen section
  • Lumpectomy margins

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates : One-year experience at an ambulatory surgical center. / Jorns, Julie M.; Visscher, Daniel W; Sabel, Michael; Breslin, Tara; Healy, Patrick; Daignaut, Stephanie; Myers, Jeffrey L.; Wu, Angela J.

In: American Journal of Clinical Pathology, Vol. 138, No. 5, 11.2012, p. 657-669.

Research output: Contribution to journalArticle

Jorns, Julie M. ; Visscher, Daniel W ; Sabel, Michael ; Breslin, Tara ; Healy, Patrick ; Daignaut, Stephanie ; Myers, Jeffrey L. ; Wu, Angela J. / Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates : One-year experience at an ambulatory surgical center. In: American Journal of Clinical Pathology. 2012 ; Vol. 138, No. 5. pp. 657-669.
@article{942f2066a3dc4de0be7cac729372365d,
title = "Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: One-year experience at an ambulatory surgical center",
abstract = "Intraoperative frozen section (FS) margin evaluation is not common practice for patients undergoing breast conservation therapy (BCT), but offers a significant reduction in reoperation. In this study, a technique to allow for more effective freezing of breast tissue was developed to perform FS evaluation of lumpectomy margins (FSM) for all patients undergoing BCT at an ambulatory surgery center. FS evaluation of sentinel lymph node biopsy specimens was performed concurrently. One hundred eighty-one study and 188 control patients, with and without FS evaluation, were compared. Reexcision was reduced 34{\%} (from 48.9{\%} to 14.9{\%}) and reoperation was reduced 36{\%} (from 55.3{\%} to 19.3{\%}) with FS evaluation. Most of the decrease in reoperative rate was because of a decrease in the need for margin reexcision. The number of patients requiring 1, 2, or 3 operations to complete therapy was 84, 92, and 12, respectively, in the control group, and 146, 33, and 2, respectively, in the study group. Lobular subtype, multifocal disease, and larger tumor size (≥2 cm) were significantly associated with failure of FSM to prevent reoperation, but reoperation rates were still significantly decreased in this subgroup of patients (from 75.5{\%} to 43.8{\%}) with FSM. This study highlights an innovative yet simple and adaptable FS approach that resulted in a nearly 3-fold reduction in reoperation for patients undergoing BCT.",
keywords = "Breast conservation therapy, Frozen section, Intraoperative frozen section, Lumpectomy margins",
author = "Jorns, {Julie M.} and Visscher, {Daniel W} and Michael Sabel and Tara Breslin and Patrick Healy and Stephanie Daignaut and Myers, {Jeffrey L.} and Wu, {Angela J.}",
year = "2012",
month = "11",
doi = "10.1309/AJCP4IEMXCJ1GDTS",
language = "English (US)",
volume = "138",
pages = "657--669",
journal = "American Journal of Clinical Pathology",
issn = "0002-9173",
publisher = "American Society of Clinical Pathologists",
number = "5",

}

TY - JOUR

T1 - Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates

T2 - One-year experience at an ambulatory surgical center

AU - Jorns, Julie M.

AU - Visscher, Daniel W

AU - Sabel, Michael

AU - Breslin, Tara

AU - Healy, Patrick

AU - Daignaut, Stephanie

AU - Myers, Jeffrey L.

AU - Wu, Angela J.

PY - 2012/11

Y1 - 2012/11

N2 - Intraoperative frozen section (FS) margin evaluation is not common practice for patients undergoing breast conservation therapy (BCT), but offers a significant reduction in reoperation. In this study, a technique to allow for more effective freezing of breast tissue was developed to perform FS evaluation of lumpectomy margins (FSM) for all patients undergoing BCT at an ambulatory surgery center. FS evaluation of sentinel lymph node biopsy specimens was performed concurrently. One hundred eighty-one study and 188 control patients, with and without FS evaluation, were compared. Reexcision was reduced 34% (from 48.9% to 14.9%) and reoperation was reduced 36% (from 55.3% to 19.3%) with FS evaluation. Most of the decrease in reoperative rate was because of a decrease in the need for margin reexcision. The number of patients requiring 1, 2, or 3 operations to complete therapy was 84, 92, and 12, respectively, in the control group, and 146, 33, and 2, respectively, in the study group. Lobular subtype, multifocal disease, and larger tumor size (≥2 cm) were significantly associated with failure of FSM to prevent reoperation, but reoperation rates were still significantly decreased in this subgroup of patients (from 75.5% to 43.8%) with FSM. This study highlights an innovative yet simple and adaptable FS approach that resulted in a nearly 3-fold reduction in reoperation for patients undergoing BCT.

AB - Intraoperative frozen section (FS) margin evaluation is not common practice for patients undergoing breast conservation therapy (BCT), but offers a significant reduction in reoperation. In this study, a technique to allow for more effective freezing of breast tissue was developed to perform FS evaluation of lumpectomy margins (FSM) for all patients undergoing BCT at an ambulatory surgery center. FS evaluation of sentinel lymph node biopsy specimens was performed concurrently. One hundred eighty-one study and 188 control patients, with and without FS evaluation, were compared. Reexcision was reduced 34% (from 48.9% to 14.9%) and reoperation was reduced 36% (from 55.3% to 19.3%) with FS evaluation. Most of the decrease in reoperative rate was because of a decrease in the need for margin reexcision. The number of patients requiring 1, 2, or 3 operations to complete therapy was 84, 92, and 12, respectively, in the control group, and 146, 33, and 2, respectively, in the study group. Lobular subtype, multifocal disease, and larger tumor size (≥2 cm) were significantly associated with failure of FSM to prevent reoperation, but reoperation rates were still significantly decreased in this subgroup of patients (from 75.5% to 43.8%) with FSM. This study highlights an innovative yet simple and adaptable FS approach that resulted in a nearly 3-fold reduction in reoperation for patients undergoing BCT.

KW - Breast conservation therapy

KW - Frozen section

KW - Intraoperative frozen section

KW - Lumpectomy margins

UR - http://www.scopus.com/inward/record.url?scp=84868130369&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84868130369&partnerID=8YFLogxK

U2 - 10.1309/AJCP4IEMXCJ1GDTS

DO - 10.1309/AJCP4IEMXCJ1GDTS

M3 - Article

C2 - 23086766

AN - SCOPUS:84868130369

VL - 138

SP - 657

EP - 669

JO - American Journal of Clinical Pathology

JF - American Journal of Clinical Pathology

SN - 0002-9173

IS - 5

ER -