title: Impact of analysis of frozen-section margin on reoperation rates in women undergoing lumpectomy for breast cancer: evaluation of the National Surgical Quality Improvement Program data.
abstract: BACKGROUND
  Reoperation for positive margins after lumpectomy for breast cancer is common. Intraoperative analysis of frozen-section (FS) margins permits immediate re-excision, avoiding reoperation. The aim of this study was to compare reoperation rates between an institution using routine FS analysis of all margins and the National Surgical Quality Improvement Program (NSQIP) data.
  
  
  METHODS
  We designed a retrospective cohort analysis comparing the NSQIP data from a FS single institution with the national NSQIP data from 2006 to 2010. Women undergoing lumpectomy for cancer were identified (N = 24,217), and reoperation rates were compared by the use of χ(2) analyses and multivariable logistic regression. During this time period, NSQIP did not differentiate between reoperations for complications or oncologic reasons. Reoperation rates for mastectomy patients (N = 21,734) and lumpectomy patients without cancer (N = 2,777) over the same time period were analyzed as controls, because reoperations after these procedures likely would be for reasons other than positive margins.
  
  
  RESULTS
  The 30-day reoperation rate after lumpectomy for cancer was greater nationally than at the FS institution (13.2% vs 3.6%, P < .001). Multivariable analysis showed that patients in the national NSQIP data set were over four times as likely to undergo reoperation as those at the FS institution's (odds ratio 4.19). The reoperation rates were similar between the two, both for patients undergoing mastectomy (4.7% vs 4.5%, P = .84) and those undergoing lumpectomy for benign diagnosis (2.9% vs 5.9%, P = .39).
  
  
  CONCLUSIONS
  Intraoperative FS margin analysis decreases the number of reoperations for patients undergoing breast conservation for breast cancer. This technique has important implications for patient satisfaction and cost of care.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: boughey.judy@mayo.edu.
authors.forename: Judy C
authors.initials: JC
authors.lastname: Boughey
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Tina J
authors.initials: TJ
authors.lastname: Hieken
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: James W
authors.initials: JW
authors.lastname: Jakub
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Degnim
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Clive S
authors.initials: CS
authors.lastname: Grant
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: David R
authors.initials: DR
authors.lastname: Farley
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Thomsen
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: John B
authors.initials: JB
authors.lastname: Osborn
authors.affiliation: Department of Laboratory Medicine/Pathology, Mayo Clinic, Rochester, MN.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Keeney
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D016015:Logistic Models; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome