Total-circumference intraoperative frozen section analysis reduces margin-positive rate in breast-conservation surgery.
OBJECTIVE
One problem existing in breast-conservation surgery is ipsilateral breast tumour recurrence, and one of its major risk factors is surgical margin positivity. We therefore investigated whether total-circumference surgical margin examination can reduce surgical margin-positive rates.


METHODS
A total of 122 cases were examined after BCS was performed between March 2004 and March 2006. After partial mastectomy, specimens were taken from the remnant breast side along the total-circumference of the mammary gland (width, approximately 5 mm). Intraoperative frozen section analysis was performed for those specimens. Margin-positive cases were defined as those showing malignancy within <or=5 mm of the final margin as revealed by final diagnosis.


RESULTS
If intraoperative frozen section analysis had not been performed, 33 cases (27%) would have been diagnosed as margin-positive. However, it reduced the number of margin-positive cases to 12 (9.8%), and final margin-positivity rates were thus significantly reduced (P < 0.001). As for the accuracy of intraoperative frozen section analysis, sensitivity was 78.6%, specificity was 100%, correct diagnosis rate was 95.1%, positive predictive value was 100% and negative predictive value was 94.0%. False-negatives were caused by the detection of malignancy as revealed in permanent specimens. Margin-positive sites were not limited to the nipple and distal (peripheral) sites, with equivalent margin-positive cases found laterally.


CONCLUSIONS
Total-circumference surgical margin examination by IFSA for BCS significantly reduced margin-positive rates from 27% to 9.8%.
Fukamachi
Kayoko
K
Department of Surgical Oncology, Tohoku University School of Medicine, Sendai 980-8574, Japan.
Ishida
Takanori
T
Usami
Shin
S
Takeda
Motohiro
M
Watanabe
Mika
M
Sasano
Hironobu
H
Ohuchi
Noriaki
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007432:Intraoperative Period; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity