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

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 intr...

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Bibliographic Details
Published in:Annals of surgical oncology 2012-10, Vol.19 (10), p.3236-3245
Main Authors: Esbona, Karla, Li, Zhanhai, Wilke, Lee G.
Format: Article
Language:English
Subjects:
Breast Neoplasms - pathology
Breast Neoplasms - surgery
Breast Oncology
Cytodiagnosis
Female
Frozen Sections
Humans
Mastectomy, Segmental
Medicine
Medicine & Public Health
Monitoring, Intraoperative
Oncology
Prognosis
Surgery
Surgical Oncology
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Summary: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  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-012-2492-2