Is frozen section margin assessment during oncoplastic breast procedures worthwhile?
Association of Breast Surgery ePoster Library. Zeidan B. 05/15/17; 166259; P093
Mr. Bashar Zeidan
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Abstract
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Background
Mastectomy rates for positive margins are higher following oncoplastic breast conserving surgery (OPBCS) than BCS1. Intraoperative frozen section (IOFS) margin assessment reduces positive final margin rates (PFM), but organizational issues and cost limit its use in the UK.
Aims and methods
A prospectively collected database of OPCS procedures (1991-2013) was interrogated to establish the utility and cost of IOFS. Correlation between IOFS, final margin status, further surgery and cost was investigated. The Mann-Whitney U test was used to calculate significance.
Results
Of 313 procedures (225 LD miniflaps [LDmi] and 88 therapeutic mammoplasties [TM]), 67% had IOFS (LDmi 76%, TM 44%). IOFS false positive and negative rates were 3.5% and 10% respectively. IOFS halved overall PFM rates (9% no IOFS v 4% IOFS, p=0.02), with similar reductions following both LDmi and TM procedures (LDmi 7% v 4%, p<0.05: TM 12% v 3%, p<0.01). Seventeen percent required further surgery (14% re-excision, 3% mastectomy). Mastectomy for PFM was carried out in 2% TM and 1% LDmi patients. Median IOFS time was 54 (42-151) minutes, with an additional pathology cost of £74 (£59-148) per patient.
Conclusion
IOFS during OPBCS significantly lowers FPMs, avoiding subsequent re-excision and mastectomy, for a small increase in pathology costs.
References
1. Losken A, Dugal CS, Styblo T, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg 2014; 72: 154-9
Mastectomy rates for positive margins are higher following oncoplastic breast conserving surgery (OPBCS) than BCS1. Intraoperative frozen section (IOFS) margin assessment reduces positive final margin rates (PFM), but organizational issues and cost limit its use in the UK.
Aims and methods
A prospectively collected database of OPCS procedures (1991-2013) was interrogated to establish the utility and cost of IOFS. Correlation between IOFS, final margin status, further surgery and cost was investigated. The Mann-Whitney U test was used to calculate significance.
Results
Of 313 procedures (225 LD miniflaps [LDmi] and 88 therapeutic mammoplasties [TM]), 67% had IOFS (LDmi 76%, TM 44%). IOFS false positive and negative rates were 3.5% and 10% respectively. IOFS halved overall PFM rates (9% no IOFS v 4% IOFS, p=0.02), with similar reductions following both LDmi and TM procedures (LDmi 7% v 4%, p<0.05: TM 12% v 3%, p<0.01). Seventeen percent required further surgery (14% re-excision, 3% mastectomy). Mastectomy for PFM was carried out in 2% TM and 1% LDmi patients. Median IOFS time was 54 (42-151) minutes, with an additional pathology cost of £74 (£59-148) per patient.
Conclusion
IOFS during OPBCS significantly lowers FPMs, avoiding subsequent re-excision and mastectomy, for a small increase in pathology costs.
References
1. Losken A, Dugal CS, Styblo T, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg 2014; 72: 154-9
Background
Mastectomy rates for positive margins are higher following oncoplastic breast conserving surgery (OPBCS) than BCS1. Intraoperative frozen section (IOFS) margin assessment reduces positive final margin rates (PFM), but organizational issues and cost limit its use in the UK.
Aims and methods
A prospectively collected database of OPCS procedures (1991-2013) was interrogated to establish the utility and cost of IOFS. Correlation between IOFS, final margin status, further surgery and cost was investigated. The Mann-Whitney U test was used to calculate significance.
Results
Of 313 procedures (225 LD miniflaps [LDmi] and 88 therapeutic mammoplasties [TM]), 67% had IOFS (LDmi 76%, TM 44%). IOFS false positive and negative rates were 3.5% and 10% respectively. IOFS halved overall PFM rates (9% no IOFS v 4% IOFS, p=0.02), with similar reductions following both LDmi and TM procedures (LDmi 7% v 4%, p<0.05: TM 12% v 3%, p<0.01). Seventeen percent required further surgery (14% re-excision, 3% mastectomy). Mastectomy for PFM was carried out in 2% TM and 1% LDmi patients. Median IOFS time was 54 (42-151) minutes, with an additional pathology cost of £74 (£59-148) per patient.
Conclusion
IOFS during OPBCS significantly lowers FPMs, avoiding subsequent re-excision and mastectomy, for a small increase in pathology costs.
References
1. Losken A, Dugal CS, Styblo T, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg 2014; 72: 154-9
Mastectomy rates for positive margins are higher following oncoplastic breast conserving surgery (OPBCS) than BCS1. Intraoperative frozen section (IOFS) margin assessment reduces positive final margin rates (PFM), but organizational issues and cost limit its use in the UK.
Aims and methods
A prospectively collected database of OPCS procedures (1991-2013) was interrogated to establish the utility and cost of IOFS. Correlation between IOFS, final margin status, further surgery and cost was investigated. The Mann-Whitney U test was used to calculate significance.
Results
Of 313 procedures (225 LD miniflaps [LDmi] and 88 therapeutic mammoplasties [TM]), 67% had IOFS (LDmi 76%, TM 44%). IOFS false positive and negative rates were 3.5% and 10% respectively. IOFS halved overall PFM rates (9% no IOFS v 4% IOFS, p=0.02), with similar reductions following both LDmi and TM procedures (LDmi 7% v 4%, p<0.05: TM 12% v 3%, p<0.01). Seventeen percent required further surgery (14% re-excision, 3% mastectomy). Mastectomy for PFM was carried out in 2% TM and 1% LDmi patients. Median IOFS time was 54 (42-151) minutes, with an additional pathology cost of £74 (£59-148) per patient.
Conclusion
IOFS during OPBCS significantly lowers FPMs, avoiding subsequent re-excision and mastectomy, for a small increase in pathology costs.
References
1. Losken A, Dugal CS, Styblo T, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg 2014; 72: 154-9
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