Predictive Factors Associated with Positive Frozen Section Margins in patient with Early Breast Cancer Underwent Breast Conservative Surgery

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Sukchai Satthaporn


Background: For early breast cancer patients undergoing breast conservative surgery (BCS), negative margins are the most important factor for local control of disease. To achieve oncologic and cosmetic outcomes, we used intraoperative frozen section analysis (IEFSA) to assess the surgical resection margins. IEFSA ensures all margins are clear from tumor and thus prevents re-operation. Objective: To establish predictive factors associated with positive frozen section margins in patients with early breast cancers underwent BCS. This will identify a group of patients who are likely to benefit from IEFSA. Method: A cohort of 225 patients, who underwent BCS with IEFSA between August, 2014 and August, 2019 was retrospectively reviewed. The outer surfaces of shaved lumpectomy margins were evaluated. A negative margin was defined as no ink on the tumor for invasive carcinoma. The presence or absence of tumor cells at surgical margins was confirmed by using permanent section analyses. The incidence of positive IEFSA was reviewed. The association between rate of positive margin and tumor characteristics was assessed by using univariate and multivariate analyses. Result: 60 patients were positive IEFSA (26.7%). Of which 60, 56 received re-excision at least one time to achieve clear margins and 3 were converted to total mastectomy. Posterior margin was found frequently positive IEFSA (35%) and followed by medial and inferior margins. In comparison with permanent section, we found that the sensitivity of IEFSA was 87.7% and specificity of IEFSA was 98.1%. The predictive factors significantly associated with positive IEFSA in univariate and multivariate analyses were tumor size more than 2 cm, tumor calcification found on imaging study, DCIS component and Ki67 >20%. Conclusion: The IEFSA used during BCS is useful to confirm clear surgical margins and preventing re-operation, especially in patient with large tumor size, calcification, DCIS component and high Ki67 index.

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นิพนธ์ต้นฉบับ (Original Article)


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