Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Die Highlights vom Kongress des American College of Cardiology 2024

Im April diskutierten die Herz-Kreislauf-Spezialisten aus der ganzen Welt auf dem  Kongress des American College of Cardiology (ACC) u.a. neue Therapieansätze bei akutem Myokardinfarkt, koronarer Herzerkrankung, kardiogenem Schock oder Aortenklappenstenose. In unserem Kongress-Dossier haben wir für Sie Berichte über die „Late-Breaking Trials“ und andere wichtige Studien zusammengestellt. 
Erweiterte Suche
Anmelden
nach oben
Annals of Surgical Oncology
Erschienen in: Annals of Surgical Oncology 10/2012

01.10.2012 | Breast Oncology

Intraoperative Imprint Cytology and Frozen Section Pathology for Margin Assessment in Breast Conservation Surgery: A Systematic Review

verfasst von: Karla Esbona, MS, Zhanhai Li, PhD, Lee G. Wilke, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 10/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

Achieving negative surgical margins is critical to minimizing the risk of tumor recurrence in patients undergoing breast conservation surgery (BCS) for a breast malignancy. Our objective was to perform a systematic review comparing reexcision rates, sensitivity and specificity of the intraoperative use of the margin assessment techniques of imprint cytology (IC) and frozen section analysis (FSA), against permanent histopathologic section (PS).

Methods

The databases PubMed, Web of Knowledge, Cochrane Library and CINAHL Plus were searched for literature published from 1997 to 2011. Original investigations of patients who underwent BCS for breast cancer that evaluated margin assessment with PS and/or IC or FSA were included. Of 182 titles identified, 41 patient cohorts from 37 articles met inclusion criteria: PS (n = 19), IC (n = 7) and FSA (n = 15). Studies were summarized qualitatively using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cohort studies and the Strength of Recommendation Taxonomy (SORT) numerical scale for diagnostic studies.

Results

The final reexcision rates after primary BCS were 35 % for PS, 11 % for IC (p = 0.001 vs. PS) and 10 % for FSA (p < 0.0001 vs. PS). For IC, reexcision rates decreased from 26 to 4 % (p = 0.18) and for FSA, reexcision rates decreased from 27 to 6 % (p < 0.0001). The pooled sensitivity of IC and FSA were 72 and 83 %. The pooled specificity of IC and FSA were 97 and 95 %. The average length of each technique was 13 min for IC and 27 min for FSA.

Conclusions

Patients who underwent BCS with intraoperative IC or FSA to assess negative surgical margins had significantly fewer secondary surgical procedures for excision of their breast malignancies.
Literatur
1.
National Institutes of Health Consensus Conference. Treatment of early-stage breast cancer. JAMA. 1991;265:391–5.CrossRef
2.
Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184:383–93.PubMedCrossRef
3.
Sabel MS. Surgical considerations in early-stage breast cancer: lessons learned and future directions. Semin Radiat Oncol. 2011;21:10–9.PubMedCrossRef
4.
Vapiwala N, Harris E, Huang WT, et al. Long-term outcome for mammographically detected ductal carcinoma in situ managed with breast conservation treatment: prognostic significance of reexcision. Cancer J. 2006;12:25–32.PubMedCrossRef
5.
Aziz D, Rawlinson E, Narod SA, et al. The role of reexcision for positive margins in optimizing local disease control after breast conserving surgery for cancer. Breast J. 2006;12:331–7.PubMedCrossRef
6.
Swanson G, Rynearson K, Symmonds R. Significance of margins of excision on breast cancer recurrence. Am J Clin Oncol. 2002;25:438–41.PubMedCrossRef
7.
Tartter PI, Kaplan J, Bleiweiss I, et al. Lumpectomy margins, reexcision and local recurrence of breast cancer. Am J Surg. 2000;179:81–5.PubMedCrossRef
8.
Wazer DE, DePetrillo T, Schmidt-Ullrich R, et al. Factors infuencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1992;10:356–63.PubMed
9.
Laucirica R. Intraoperative assessment of the breast—guidelines and potential pitfalls. Arch Pathol Lab Med. 2005;129:1565–74.PubMed
10.
Weinberg E, Cox C, Dupont E, et al. Local recurrence in lumpectomy patients after imprint cytology margin evaluation. Am J Surg. 2004;188:349–54.PubMedCrossRef
11.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9.CrossRef
12.
Ebell MH, Siwek J, Weiss BD, et al. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician. 2004;69:548–56.PubMed
13.
D’Halluin F, Tas P, Coue O, et al. Role of intraoperative imprint cytology for evaluation of surgical margins in breast cancer: a prospective controlled study about 400 lumpectomy. Virchows Arch. 2008;452:S24–5.
14.
Cabioglu N, Hunt KK, Sahin AA, et al. Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol. 2007;14:1458–71.PubMedCrossRef
15.
Camp ER, McAuliffe PF, Gilroy JS, et al. Minimizing local recurrence after breast conserving therapy using intraoperative shaved margins to determine pathologic tumor clearance. J Am Coll Surg. 2005;201:855–61.PubMedCrossRef
16.
Loibl S, von Minckwitz G, Raab G, et al. Surgical procedures after neoadjuvant chemotherapy in operable breast cancer: results of the GEPARDUO trial. Ann Surg Oncol. 2006;13:1434–42.PubMedCrossRef
17.
Valdes EK, Boolbol SK, Ali I, Feldman SM, Cohen JM. Intraoperative touch preparation cytology for margin assessment in breast-conservation surgery: does it work for lobular carcinoma? Ann Surg Oncol. 2007;14:2940–5.PubMedCrossRef
18.
Rusby JE, Paramanathan N, Laws SA, Rainsbury RM. Immediate latissimus dorsi miniflap volume replacement for partial mastectomy: use of intra-operative frozen sections to confirm negative margins. Am J Surg. 2008;196:512–8.PubMedCrossRef
19.
Fukamachi K, Ishida T, Usami S, et al. Total-circumference intraoperative frozen section analysis reduces margin-positive rate in breast-conservation surgery. Jpn J Clin Oncol. 2010;40:513–20.PubMedCrossRef
20.
Munhoz AM, Montag E, Arruda E, et al. Immediate reconstruction following breast-conserving surgery: management of the positive surgical margins and influence on secondary reconstruction. Breast. 2009;18:47–54.PubMedCrossRef
21.
Riedl O, Fitzal F, Mader N, et al. Intraoperative frozen section analysis for breast-conserving therapy in 1016 patients with breast cancer. Eur J Surg Oncol. 2009;35:264–70.PubMedCrossRef
22.
Uecker JM, Bui EH, Foulkrod KH, Sabra JP. Intraoperative assessment of breast cancer specimens decreases cost and number of reoperations. Am Surg. 2011;77:342–4.PubMed
23.
Osborn JB, Keeney GL, Jakub JW, Degnim AC, Boughey JC. Cost-effectiveness analysis of routine frozen-section analysis of breast margins compared with reoperation for positive margins. Ann Surg Oncol. 2011;18:3204–9.PubMedCrossRef
24.
Arora S, Menes TS, Moung C, Nagi C, Bleiweiss I, Jaffer S. Atypical ductal hyperplasia at margin of breast biopsy—is re-excision indicated? Ann Surg Oncol. 2008;15:843–7.PubMedCrossRef
25.
Huston TL, Pigalarga R, Osborne MP, Tousimis E. The influence of additional surgical margins on the total specimen volume excised and the reoperative rate after breast-conserving surgery. Am J Surg. 2006;192:509–12.PubMedCrossRef
26.
Landercasper J, Ellis RL, Mathiason MA, et al. A community breast center report card determined by participation in the National Quality Measures for Breast Centers program. Breast J. 2010;16:472–80.PubMedCrossRef
27.
McCahill LE, Single R, Ratliff J, Sheehey-Jones J, Gray A, James T. Local recurrence after partial mastectomy: relation to initial surgical margins. Am J Surg. 2011;201:374–8.PubMedCrossRef
28.
Menes TS, Tartter PI, Bleiweiss I, Godbold JH, Estabrook A, Smith SR. The consequence of multiple re-excisions to obtain clear lumpectomy margins in breast cancer patients. Ann Surg Oncol. 2005;12:881–5.PubMedCrossRef
29.
Miller AR, Brandao G, Prihoda TJ, Hill C, Cruz AB, Yeh IT. Positive margins following surgical resection of breast carcinoma: analysis of pathologic correlates. J Surg Oncol. 2004;86:134–40.PubMedCrossRef
30.
Moorthy K, Asopa V, Wiggins E, Callam M. Is the reexcision rate higher if breast conservation surgery is performed by surgical trainees? Am J Surg. 2004;188:45–8.PubMedCrossRef
31.
Mullenix PS, Cuadrado DG, Steele SR, et al. Secondary operations are frequently required to complete the surgical phase of therapy in the era of breast conservation and sentinel lymph node biopsy. Am J Surg. 2004;187:643–6.PubMedCrossRef
32.
Ooi CWL, Serpell JW, Rodger A. Tumour involvement of the re-excision specimen following clear local excision of breast cancer with positive margins. ANZ J Surg. 2003;73:979–82.PubMedCrossRef
33.
O’Sullivan MJ, Li T, Freedman G, Morrow M. The effect of multiple reexcisions on the risk of local recurrence after breast conserving surgery. Ann Surg Oncol. 2007;14:3133–40.PubMedCrossRef
34.
Perez CA. Conservation therapy in T1–T2 breast cancer: past, current issues, and future challenges and opportunities. Cancer J. 2003;9:442–53.PubMedCrossRef
35.
Ramanah R, Pivot X, Sautiere JL, Maillet R, Riethmuller D. Predictors of re-excision for positive or close margins in breast-conservation therapy for pT1 tumors. Am J Surg. 2008;195:770–4.PubMedCrossRef
36.
Sanchez C, Brem RF, McSwain AR, Rapelyea JA, Torrente J, Teal CB. Factors associated with re-excision in patients with early-stage breast cancer treated with breast conservation therapy. Am Surg. 2010;76:331–4.PubMed
37.
van den Broek N, van der Sangen MJ, van de Poll-Franse LV, van Beek MW, Nieuwenhuijzen GA, Voogd AC. Margin status and the risk of local recurrence after breast-conserving treatment of lobular breast cancer. Breast Cancer Res Treat. 2007;105:63–8.PubMedCrossRef
38.
Vicini FA, Kestin LL, Goldstein NS, Baglan KL, Pettinga JE, Martinez AA. Relationship between excision volume, margin status, and tumor size with the development of local recurrence in patients with ductal carcinoma-in-situ treated with breast-conserving therapy. J Surg Oncol. 2001;76:245–54.PubMedCrossRef
39.
Barros AC, Pinotti M, Teixeira LC, Ricci MD, Pinotti JA. Outcome analysis of patients with early infiltrating breast carcinoma treated by surgery with intraoperative evaluation of surgical margins. Tumori. 2004;90:592–5.PubMed
40.
Cox CE, Hyacinthe M, Gonzalez RJ, et al. Cytologic evaluation of lumpectomy margins in patients with ductal carcinoma in situ: clinical outcome. Ann Surg Oncol. 1997;4:644–9.PubMedCrossRef
41.
D’Halluin F, Tas P, Rouquette S, et al. Intra-operative touch preparation cytology following lumpectomy for breast cancer: a series of 400 procedures. Breast. 2009;18:248–53.PubMedCrossRef
42.
Klimberg VS, Westbrook KC, Korourian S. Use of touch preps for diagnosis and evaluation of surgical margins in breast cancer. Ann Surg Oncol. 1998;5:220–6.PubMedCrossRef
43.
Cendan JC, Coco D, Copeland EM 3rd. Accuracy of intraoperative frozen-section analysis of breast cancer lumpectomy-bed margins. J Am Coll Surg. 2005;201:194–8.PubMedCrossRef
44.
Chen WH, Cheng SP, Tzen CY, et al. Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. 2005;91:185–94.PubMedCrossRef
45.
Dener C, Inan A, Sen M, Demirci S. Interoperative frozen section for margin assessment in breast conserving energy. Scand J Surg. 2009;98:34–40.PubMed
46.
Ikeda T, Enomoto K, Wada K, et al. Frozen-section-guided breast-conserving surgery: implications of diagnosis by frozen section as a guide to determining the extent of resection. Surg Today. 1997;27:207–12.PubMedCrossRef
47.
Olson TP, Harter J, Muñoz A, Mahvi DM, Breslin T. Frozen section analysis for intraoperative margin assessment during breast-conserving surgery results in low rates of re-excision and local recurrence. Ann Surg Oncol. 2007;14:2953–60.PubMedCrossRef
48.
Park S, Park HS, Kim SI, Koo JS, Park BW, Lee KS. The impact of a focally positive resection margin on the local control in patients treated with breast-conserving therapy. Jpn J Clin Oncol. 2011;41:600–8.PubMedCrossRef
49.
Weber S, Storm FK, Stitt J, Mahvi DM. The role of frozen section analysis of margins during breast conservation surgery. Cancer J Sci Am. 1997;3:273–7.PubMed
50.
Weber WP, Engelberger S, Viehl CT, et al. Accuracy of frozen section analysis versus specimen radiography during breast-conserving surgery for nonpalpable lesions. World J Surg. 2008;32:2599–606.PubMedCrossRef
Metadaten
Titel
Intraoperative Imprint Cytology and Frozen Section Pathology for Margin Assessment in Breast Conservation Surgery: A Systematic Review
verfasst von
Karla Esbona, MS
Zhanhai Li, PhD
Lee G. Wilke, MD
Publikationsdatum
01.10.2012
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 10/2012
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2492-2

Weitere Artikel der Ausgabe 10/2012

Annals of Surgical Oncology 10/2012 Zur Ausgabe

Breast Oncology

Gender Differences in Breast Cancer: Analysis of 13,000 Breast Cancers in Men from the National Cancer Data Base

Breast Oncology

Autologous Inferior Dermal Sling (Autoderm) with Concomitant Skin-Envelope Reduction Mastectomy: An Excellent Surgical Choice for Women with Macromastia and Clinically Significant Ptosis

Breast Oncology

Breast Surgery Outcomes as Quality Measures According to the NSQIP Database

Breast Oncology

American Society of Breast Surgeons Presidential Address: Could Quality Measures Impede Quality Care?

Breast Oncology

Y-V Oncoplastic Wound Repair of Mastectomy Dog-Ear Deformity

Breast Oncology

Editorial: Sentinel Node Biopsy for Breast Cancer: Past, Present, and Future

Neu im Fachgebiet Chirurgie

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Was nützt die Kraniektomie bei schwerer tiefer Hirnblutung?

17.05.2024 Hirnblutung Nachrichten

Eine Studie zum Nutzen der druckentlastenden Kraniektomie nach schwerer tiefer supratentorieller Hirnblutung deutet einen Nutzen der Operation an. Für überlebende Patienten ist das dennoch nur eine bedingt gute Nachricht.

Klinikreform soll zehntausende Menschenleben retten

15.05.2024 Klinik aktuell Nachrichten

Gesundheitsminister Lauterbach hat die vom Bundeskabinett beschlossene Klinikreform verteidigt. Kritik an den Plänen kommt vom Marburger Bund. Und in den Ländern wird über den Gang zum Vermittlungsausschuss spekuliert.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.
Bildnachweise