title: Is intraoperative frozen section analysis of reexcision specimens of value in preventing reoperation in breast-conserving therapy?
abstract: OBJECTIVE
  A prior study at our institution showed a marked reduction in reoperation for margin reexcision following the development of an intraoperative frozen section evaluation of margins (FSM) practice on lumpectomy specimens from patients undergoing breast-conserving therapy (BCT). This study aimed to examine the frequency of FSM utilization, FSM pathology performance, and outcomes for BCT patients undergoing margin reexcision only.
  
  
  METHODS
  Consecutive reexcision-only specimens were reviewed from a 40-month period following the development of the FSM practice. Clinicopathologic features and patient outcomes were assessed.
  
  
  RESULTS
  FSM was performed in 46 (30.7%) of 150 reexcision-only operations. Of the 46 operations with FSM, there were 28 (60.9%) true-negative, 12 (26.1%) true-positive, six (13.0%) false-negative, and no false-positive cases. There was no difference in further reexcision, total operations, or conversion to mastectomy among patients with and without FSM. Need for further reexcision was significantly associated with tumor multifocality (P = .008).
  
  
  CONCLUSIONS
  Despite overall good pathology performance for FSM in reexcision-only specimens, use of FSM did not affect patient outcome. Rather, underlying disease biology appeared most significant in predicting whether adequate surgical margins could be attained.
authors.affiliation: From the Department of Pathology, jjorns@med.umich.edu.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Jorns
authors.affiliation: Center for Cancer Biostatistics, School of Public Health, and.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Daignault
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Sabel
authors.affiliation: From the Department of Pathology.
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D005629:Frozen Sections; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology*; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000473:pathology*; D012086:Reoperation
keywords: Breast conservation therapy; Frozen section; Intraoperative frozen section; Lumpectomy margins; Reexcision