Use of Intraoperative Frozen Section Margin Assessment May Decrease Reoperations in Breast Cancer Patients Undergoing Lumpectomy
In female patients undergoing breast cancer lumpectomies, intraoperative frozen section margin assessment has been shown to decrease overall reoperation rates, according to the results of a study reported by Boughey et al in the journal Surgery. This finding may lead to lower health-care costs, a reduction in future surgeries, and improved cancer outcomes.
More than 13% of U.S. women who undergo lumpectomies to remove cancerous breast tissue are likely to need a second surgery as soon as 30 days after their first procedure. This is largely due to the discovery of positive margins found in postoperative analysis that were not detected or removed during the initial surgery. The need for reoperation to remove these positive margins can be problematic for both patients and surgeons.
To lower the number of patients who will require reoperation, clinicians at the Mayo Clinic have instituted intraoperative frozen section margin assessment, which is performed routinely while the patient remains in surgery. This enables surgeons to immediately reexcise positive or close margins during the initial surgery, thus minimizing the need for a second operation. After routinely utilizing this margin assessment process, investigators at the clinic conducted a study to determine the overall value of this approach.
Study Details
The investigators analyzed the medical records of 24,217 women who underwent lumpectomy for breast cancer. Patient records were obtained from the National Surgical Quality Improvement Program for the years 2006 to 2010. Comparisons were made between national data and the data from the Mayo Clinic.
Patients were divided into three groups: those who underwent lumpectomy for breast cancer, those who underwent lumpectomy for other noncancer indications, and those who underwent mastectomy for breast cancer. These patients were analyzed according to the 30-day reoperation rate. Other factors taken from medical records that were examined included patient age, body mass index, status (if any) of diabetes mellitus, steroid use, hypertension, and prior chemotherapy. Patients from the Mayo Clinic group were more likely to have received chemotherapy.
Fewer Reoperations
The reoperation rate for patients in the group receiving intraoperative frozen section margin assessment (the Mayo Clinic Group) was 3.6% compared with 13.2% in patients not receiving immediate frozen section margin assessment (the National Group). Multivariable results indicated that patients in the National Group were over four times more likely to undergo reoperation than were patients from the Mayo Clinic Group in the 30 days following lumpectomy (odds ratio = 4.19, 95% confidence interval [CI] = 2.29–7.66).
The investigators noted that of all patients undergoing lumpectomy, younger patients (40–59 years) were more likely to require reoperation than those who were 60 years of age and older. In addition, women who were underweight were more likely to require reoperation than those who were of normal weight. Reoperation rates were not affected by the other factors analyzed.
As for reoperation rates among women who underwent mastectomies, there was no significant difference between patients in the two groups (4.7% in the National Group and 4.5% in the Mayo Clinic Group). The same held true in women who underwent lumpectomy for noncancer indications (2.9% in the National Group and 5.9% in the Mayo Clinic Group).
Clinical Implications
These findings show that a comprehensive intraoperative pathologic-specific assessment performed intraoperatively reduces the need for reoperation in women undergoing lumpectomy. This approach may enable clinicians to reduce health-care costs and enhance patient outcomes. Although complete intraoperative pathologic analysis can be costly and time-consuming, these factors can be offset by the decrease in the number of reoperations, which are associated with patient psychosocial stress, cosmesis, and infections.
The investigators concluded, “The use of intraoperative frozen section margin assessment can successfully decrease reoperations for margin control and therefore decrease overall reoperation rates for women undergoing breast conservation for breast cancer. This not only improves the quality of care, but provides cost-effective care.”
Judy C. Boughey, MD, of the Department of Surgery, Mayo Clinic, Rochester, Minnesota, is the corresponding author for the Surgery article.
The authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
