Is frozen section analysis of reexcision lumpectomy margins worthwhile? Margin analysis in breast reexcisions
Background. The authors performed reexcision lumpectomy on patients with breast cancer with tumor at or close to the resection margin or if the margin status was unknown. Frozen section analysis (FSA) of reexcision lumpectomy margins was performed to allow additional excision of margins or mastectom...
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| Veröffentlicht in: | Cancer 1994-05, Vol.73 (10), p.2607-2612 |
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| creator | Sauter, Edward R. Hoffman, John P. Ottery, Faith D. Kowalyshyn, Michael J. Litwin, Samuel Eisenberg, Burton L. |
| description | Background. The authors performed reexcision lumpectomy on patients with breast cancer with tumor at or close to the resection margin or if the margin status was unknown. Frozen section analysis (FSA) of reexcision lumpectomy margins was performed to allow additional excision of margins or mastectomy, saving the patient another operation or an additional radiation boost.
Methods. The authors reviewed the accuracy of FSA of margins in 107 patients undergoing reexcision lumpectomy between 1987 and 1992. There were 359 frozen sections performed on 156 specimens. Sensitivity and specificity of FSA for each frozen section margin, specimen, and patient were evaluated, as was gross inspection of tumor involvement at the resection margins. The accuracy of each pathologist's use of FSA also was evaluated.
Results. FSA sensitivity per frozen section margin, specimen, and patient was 0.90, 0.89, and 0.85, respectively. The specificity of gross inspection was 0.97, 0.96, and 0.96 (sensitivity, 0.44), which was significantly less accurate than that of FSA (P = 0.0015) or permanent section (P = 0.019). There was no significant discordance between FSA and permanent section.
Of 19 pathologists doing FSA, 6 evaluated 10 or more specimens. The error rate ranged from 4% to 10% among pathologists with 10 or more readings, whereas 12 of 13 pathologists with fewer readings had no errors. The final pathologist had a 100% error rate, significantly worse (range, P = 0.0085–0.02) than any experienced pathologist.
Thirty‐four (32%) patients underwent additional excision (24 patients) or mastectomy (10 patients) based on the results of FSA, which saved the patients from undergoing another operation. No one required an additional operation or a mastectomy because of a false FSA result.
Conclusions. FSA is safe and accurate in evaluating reexcision lumpectomy margins. Gross inspection is not reliable in margin evaluation. FSA saved an additional operation 32% of the time. Obtaining clear margins during one procedure eliminates the necessity of an additional radiation boost and probably will improve cosmesis. |
| doi_str_mv | 10.1002/1097-0142(19940515)73:10<2607::AID-CNCR2820731023>3.0.CO;2-1 |
| format | Article |
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Methods. The authors reviewed the accuracy of FSA of margins in 107 patients undergoing reexcision lumpectomy between 1987 and 1992. There were 359 frozen sections performed on 156 specimens. Sensitivity and specificity of FSA for each frozen section margin, specimen, and patient were evaluated, as was gross inspection of tumor involvement at the resection margins. The accuracy of each pathologist's use of FSA also was evaluated.
Results. FSA sensitivity per frozen section margin, specimen, and patient was 0.90, 0.89, and 0.85, respectively. The specificity of gross inspection was 0.97, 0.96, and 0.96 (sensitivity, 0.44), which was significantly less accurate than that of FSA (P = 0.0015) or permanent section (P = 0.019). There was no significant discordance between FSA and permanent section.
Of 19 pathologists doing FSA, 6 evaluated 10 or more specimens. The error rate ranged from 4% to 10% among pathologists with 10 or more readings, whereas 12 of 13 pathologists with fewer readings had no errors. The final pathologist had a 100% error rate, significantly worse (range, P = 0.0085–0.02) than any experienced pathologist.
Thirty‐four (32%) patients underwent additional excision (24 patients) or mastectomy (10 patients) based on the results of FSA, which saved the patients from undergoing another operation. No one required an additional operation or a mastectomy because of a false FSA result.
Conclusions. FSA is safe and accurate in evaluating reexcision lumpectomy margins. Gross inspection is not reliable in margin evaluation. FSA saved an additional operation 32% of the time. Obtaining clear margins during one procedure eliminates the necessity of an additional radiation boost and probably will improve cosmesis.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/1097-0142(19940515)73:10<2607::AID-CNCR2820731023>3.0.CO;2-1</identifier><identifier>PMID: 8174059</identifier><identifier>CODEN: CANCAR</identifier><language>eng</language><publisher>New York: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Biological and medical sciences ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; breast reexcision margins ; False Negative Reactions ; False Positive Reactions ; Female ; frozen section analysis ; Frozen Sections ; gross inspection ; Humans ; lumpectomy margins ; Mastectomy, Segmental ; Medical sciences ; Reoperation ; Sensitivity and Specificity ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the genital tract and mammary gland</subject><ispartof>Cancer, 1994-05, Vol.73 (10), p.2607-2612</ispartof><rights>Copyright © 1994 American Cancer Society</rights><rights>1994 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c4163-c403e370985f9c49ae892feadb570a7bd7b74e6d2c26c28c72646c4fc65abdd53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,776,780,785,786,23909,23910,25118,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=4165013$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8174059$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sauter, Edward R.</creatorcontrib><creatorcontrib>Hoffman, John P.</creatorcontrib><creatorcontrib>Ottery, Faith D.</creatorcontrib><creatorcontrib>Kowalyshyn, Michael J.</creatorcontrib><creatorcontrib>Litwin, Samuel</creatorcontrib><creatorcontrib>Eisenberg, Burton L.</creatorcontrib><title>Is frozen section analysis of reexcision lumpectomy margins worthwhile? Margin analysis in breast reexcisions</title><title>Cancer</title><addtitle>Cancer</addtitle><description>Background. The authors performed reexcision lumpectomy on patients with breast cancer with tumor at or close to the resection margin or if the margin status was unknown. Frozen section analysis (FSA) of reexcision lumpectomy margins was performed to allow additional excision of margins or mastectomy, saving the patient another operation or an additional radiation boost.
Methods. The authors reviewed the accuracy of FSA of margins in 107 patients undergoing reexcision lumpectomy between 1987 and 1992. There were 359 frozen sections performed on 156 specimens. Sensitivity and specificity of FSA for each frozen section margin, specimen, and patient were evaluated, as was gross inspection of tumor involvement at the resection margins. The accuracy of each pathologist's use of FSA also was evaluated.
Results. FSA sensitivity per frozen section margin, specimen, and patient was 0.90, 0.89, and 0.85, respectively. The specificity of gross inspection was 0.97, 0.96, and 0.96 (sensitivity, 0.44), which was significantly less accurate than that of FSA (P = 0.0015) or permanent section (P = 0.019). There was no significant discordance between FSA and permanent section.
Of 19 pathologists doing FSA, 6 evaluated 10 or more specimens. The error rate ranged from 4% to 10% among pathologists with 10 or more readings, whereas 12 of 13 pathologists with fewer readings had no errors. The final pathologist had a 100% error rate, significantly worse (range, P = 0.0085–0.02) than any experienced pathologist.
Thirty‐four (32%) patients underwent additional excision (24 patients) or mastectomy (10 patients) based on the results of FSA, which saved the patients from undergoing another operation. No one required an additional operation or a mastectomy because of a false FSA result.
Conclusions. FSA is safe and accurate in evaluating reexcision lumpectomy margins. Gross inspection is not reliable in margin evaluation. FSA saved an additional operation 32% of the time. Obtaining clear margins during one procedure eliminates the necessity of an additional radiation boost and probably will improve cosmesis.</description><subject>Biological and medical sciences</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>breast reexcision margins</subject><subject>False Negative Reactions</subject><subject>False Positive Reactions</subject><subject>Female</subject><subject>frozen section analysis</subject><subject>Frozen Sections</subject><subject>gross inspection</subject><subject>Humans</subject><subject>lumpectomy margins</subject><subject>Mastectomy, Segmental</subject><subject>Medical sciences</subject><subject>Reoperation</subject><subject>Sensitivity and Specificity</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the genital tract and mammary gland</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1994</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVUWtrE0EUHYpSY_QnCPtBpP2w8c5rZzctlrL1EagGioIfCsPs7Gy7so84NyHGX--sidH2g1AY5nHPuYc75xByQWFCAdhrCpmKgQp2RLNMgKTyWPEphVOWgJpOz2cXcf4pv2IpA8UpMP6GT2CSz09YTA_IaN_-iIwAII2l4F-fkKeI38JTMckPyWFKVVDORqSdYVT5_qfrInR2WfddZDrTbLDGqK8i79wPW-NQblbtIjD6dhO1xt_UHUbr3i9v17d1486ij79rf5vDvfDO4PIfDXxGHlemQfd8d47Jl3dvP-cf4sv5-1l-fhlbQRMeduCOK8hSWWVWZMalGaucKQupwKiiVIUSLimZZYllqVUsEYkVlU2kKcpS8jF5tdVd-P77yuFStzVa1zSmc_0KtUpEWMG6MbneEq3vEb2r9MLX4XsbTUEPaejBTj3Yqf-koRUf0CENrUMa-m4ammvQ-VyHhiD_YjfHqmhduRff2R_wlzvcoDVN5U0XnNrTghkSKA-0my1tHazePHDE_054D-G_ALugtqc</recordid><startdate>19940515</startdate><enddate>19940515</enddate><creator>Sauter, Edward R.</creator><creator>Hoffman, John P.</creator><creator>Ottery, Faith D.</creator><creator>Kowalyshyn, Michael J.</creator><creator>Litwin, Samuel</creator><creator>Eisenberg, Burton L.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><general>Wiley-Liss</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19940515</creationdate><title>Is frozen section analysis of reexcision lumpectomy margins worthwhile? Margin analysis in breast reexcisions</title><author>Sauter, Edward R. ; Hoffman, John P. ; Ottery, Faith D. ; Kowalyshyn, Michael J. ; Litwin, Samuel ; Eisenberg, Burton L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4163-c403e370985f9c49ae892feadb570a7bd7b74e6d2c26c28c72646c4fc65abdd53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1994</creationdate><topic>Biological and medical sciences</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - surgery</topic><topic>breast reexcision margins</topic><topic>False Negative Reactions</topic><topic>False Positive Reactions</topic><topic>Female</topic><topic>frozen section analysis</topic><topic>Frozen Sections</topic><topic>gross inspection</topic><topic>Humans</topic><topic>lumpectomy margins</topic><topic>Mastectomy, Segmental</topic><topic>Medical sciences</topic><topic>Reoperation</topic><topic>Sensitivity and Specificity</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the genital tract and mammary gland</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sauter, Edward R.</creatorcontrib><creatorcontrib>Hoffman, John P.</creatorcontrib><creatorcontrib>Ottery, Faith D.</creatorcontrib><creatorcontrib>Kowalyshyn, Michael J.</creatorcontrib><creatorcontrib>Litwin, Samuel</creatorcontrib><creatorcontrib>Eisenberg, Burton L.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sauter, Edward R.</au><au>Hoffman, John P.</au><au>Ottery, Faith D.</au><au>Kowalyshyn, Michael J.</au><au>Litwin, Samuel</au><au>Eisenberg, Burton L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is frozen section analysis of reexcision lumpectomy margins worthwhile? Margin analysis in breast reexcisions</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>1994-05-15</date><risdate>1994</risdate><volume>73</volume><issue>10</issue><spage>2607</spage><epage>2612</epage><pages>2607-2612</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><coden>CANCAR</coden><abstract>Background. The authors performed reexcision lumpectomy on patients with breast cancer with tumor at or close to the resection margin or if the margin status was unknown. Frozen section analysis (FSA) of reexcision lumpectomy margins was performed to allow additional excision of margins or mastectomy, saving the patient another operation or an additional radiation boost.
Methods. The authors reviewed the accuracy of FSA of margins in 107 patients undergoing reexcision lumpectomy between 1987 and 1992. There were 359 frozen sections performed on 156 specimens. Sensitivity and specificity of FSA for each frozen section margin, specimen, and patient were evaluated, as was gross inspection of tumor involvement at the resection margins. The accuracy of each pathologist's use of FSA also was evaluated.
Results. FSA sensitivity per frozen section margin, specimen, and patient was 0.90, 0.89, and 0.85, respectively. The specificity of gross inspection was 0.97, 0.96, and 0.96 (sensitivity, 0.44), which was significantly less accurate than that of FSA (P = 0.0015) or permanent section (P = 0.019). There was no significant discordance between FSA and permanent section.
Of 19 pathologists doing FSA, 6 evaluated 10 or more specimens. The error rate ranged from 4% to 10% among pathologists with 10 or more readings, whereas 12 of 13 pathologists with fewer readings had no errors. The final pathologist had a 100% error rate, significantly worse (range, P = 0.0085–0.02) than any experienced pathologist.
Thirty‐four (32%) patients underwent additional excision (24 patients) or mastectomy (10 patients) based on the results of FSA, which saved the patients from undergoing another operation. No one required an additional operation or a mastectomy because of a false FSA result.
Conclusions. FSA is safe and accurate in evaluating reexcision lumpectomy margins. Gross inspection is not reliable in margin evaluation. FSA saved an additional operation 32% of the time. Obtaining clear margins during one procedure eliminates the necessity of an additional radiation boost and probably will improve cosmesis.</abstract><cop>New York</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>8174059</pmid><doi>10.1002/1097-0142(19940515)73:10<2607::AID-CNCR2820731023>3.0.CO;2-1</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Cancer, 1994-05, Vol.73 (10), p.2607-2612 |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Biological and medical sciences Breast Neoplasms - pathology Breast Neoplasms - surgery breast reexcision margins False Negative Reactions False Positive Reactions Female frozen section analysis Frozen Sections gross inspection Humans lumpectomy margins Mastectomy, Segmental Medical sciences Reoperation Sensitivity and Specificity Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the genital tract and mammary gland |
| title | Is frozen section analysis of reexcision lumpectomy margins worthwhile? Margin analysis in breast reexcisions |
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