THE ROLE OF FROZEN-SECTION ANALYSIS OF MARGINS DURING BREAST-CONSERVATION SURGERY

PURPOSE The role of frozen section analysis during breast conservation surgery is undefined. Assessment of margins using permanent section e valuation is the standard method of ensuring complete tumor excision. If the margin is positive, however, surgical re-excision is necessary to reduce the likelihood of subsequent local recurrence. Therefore, bi opsy of the surgical cavity with immediate pathological evaluation dur ing lumpectomy was performed to evaluate the effect on local recurrenc e, the number of re-excisions, and cosmesis. PATIENTS AND METHODS One hundred sixty patients underwent attempted lumpectomy with frozen sect ion margin determination. One hundred forty patients were available fo r long-term follow-up (mean = 57 months, median = 46 months). All pati ents underwent attempted breast conservation surgery, which consisted of tumorectomy with excision of a greater than 1-cm rim of grossly nor mal tissue. Tumor margins were obtained by intraoperative biopsy with frozen section analysis of the lumpectomy cavity walls. RESULTS In 21 patients (15%), frozen section analyses (FSA) revealed positive margin s, resulting in immediate re-excision. In seven of these patients (5%) , margins were persistently positive, and these patients therefore und erwent mastectomy. Fourteen patients were successfully re-excised to a negative margin, The sensitivity and specificity of FSA were 91% and 100%, respectively. Five percent of patients definitively managed by l umpectomy with FSA of margins recurred locally. The mean cosmesis scor e after radiotherapy was 7.0 out of a possible 10, correlating with a good to excellent result. DISCUSSION The accuracy of FSA, low recurren ce rate, avoidance of reoperation, and good cosmesis indicate that int raoperative frozen section analysis should be adopted as a safe and ef fective method of margin analysis during breast conservation surgery.