Accuracy of gross intraoperative margin assessment for breast cancer: experience since the SSO-ASTRO margin consensus guidelines

Nunez, Alberto; Jones, Veronica; Schulz-Costello, Katherine; Schmolze, Daniel

doi:10.1038/s41598-020-74373-6

Cited by 31 publications

(18 citation statements)

References 48 publications

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“…Data from a cohort study, which included 24,217 patients, showed those that did not use frozen section during surgical procedures were four times more likely to need reoperation than women who underwent a lumpectomy for breast cancer followed by a frozen section procedure [ 12 ]. Despite the advantages of macroscopic analysis, this procedure can be performed directly by the surgeon, and boasts of higher accuracy (80%), sensitivity (49%) and specificity (86%) than other techniques [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of frozen section in intraoperative margin assessment for breast-conserving surgery: A systematic review and meta-analysis

et al. 2021

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Background and objectives It is well established that tumor-free margin is an important factor for reducing local recurrence and reoperation rates. This systematic review with meta-analysis of frozen section intraoperative margin assessment aims to evaluate the accuracy, and reoperation and survival rates, and to establish its importance in breast-conserving surgery. Methods A thorough review was conducted in all online publication-databases for the related literature up to March 2020. MeSH terms used: “Breast Cancer”, “Segmental Mastectomy” and “Frozen Section”. We included the studies that evaluated accuracy of frozen section, reoperation and survival rates. To ensure quality of the included articles, the QUADAS-2 tool (adapted) was employed. The assessment of publication bias by graphical and statistical methods was performed using the funnel plot and the Egger’s test. The review protocol was registered in PROSPERO (CRD42019125682). Results Nineteen studies were deemed suitable, with a total of 6,769 cases. The reoperation rate on average was 5.9%. Sensitivity was 0.81, with a Confidence Interval of 0.79–0.83, p = 0.0000, I2 = 95.1%, and specificity was 0.97, with a Confidence Interval of 0.97–0.98, p = 0.0000, I-2 = 90.8%, for 17 studies and 5,615 cases. Accuracy was 0.98. Twelve studies described local recurrence and the highest cumulative recurrence rate in 3 years was 7.5%. The quality of the included studies based on the QUADAS-2 tool showed a low risk of bias. There is no publication bias (p = 0.32) and the funnel plot showed symmetry. Conclusion Frozen section is a reliable procedure with high accuracy, sensitivity and specificity in intraoperative margin assessment of breast-conserving surgery. Therefore, this modality of margin assessment could be useful in reducing reoperation rates.

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Section: Introductionmentioning

confidence: 99%

Accuracy of frozen section in intraoperative margin assessment for breast-conserving surgery: A systematic review and meta-analysis

et al. 2021

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“…There is evidence that positive surgical margins are closely associated with local recurrence. [ 2 , 8 , 9 , 24 ] Intra-operative gross inspection, [ 25 ] imprint cytology, [ 26 ] intra-operative specimen imaging, [ 27 ] and novel devices [ 28 , 29 ] can also reportedly reduce the rates of positive margins. However, the panel does not recommend these approaches because of the lack of high-level evidence.…”

Section: Discussionmentioning

confidence: 99%

Clinical practice guideline for breast-conserving surgery in patients with early-stage breast cancer: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021

Chen

Liu

et al. 2021

Chinese Medical Journal

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Breast-conserving surgery (BCS) with radiotherapy is the primarily agreed surgical choice for eligible patients with an early diagnosis of breast cancer. In 2019, the panel of Chinese experts assembled by the Chinese Society for Breast Surgery (CSBrS) developed a Chinese experts' consensus on BCS for early-stage breast cancer (Version 2019) with the aim of standardizing BCS in China. Subsequently, the CSBrS conducted a review of published reports and discussions between experts to determine the key clinical questions for the Clinical Practice Guideline for BCS in Patients with Early-Stage Breast Cancer. The group evaluated the relevant evidence using the grading of recommendations assessment, development, and evaluation system, and developed a Clinical Practice Guideline for BCS in Patients with Early-Stage Breast Cancer (Version 2021), with the aim of providing guidance on clinical practice to breast surgeons in China. Level of Evidence and Recommendation StrengthLevel of evidence standard [1] Recommendation strength standard [1] Recommendation strength review committeeThe panel for this guideline is comprised of 85 experts, including 70 (82.3%) breast surgeons, four (4.7%) medical oncologists, four (4.7%) diagnostic radiologists, two (2.4%) pathologists, one (1.2%) obstetrician, two (2.4%) radiation oncologists, and two (2.4%) epidemiologists.

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“…Many studies were focussed on margin assessment of NACT cases. 18,19 All of these methods evaluated tumour side margins.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of cancer diagnostic probe for intra‐surgical checking of cavity side margins in neoadjuvant breast cancer cases: A human model study

Dabbagh

Abbasvandi

Miripour

et al. 2021

Robotics Computer Surgery

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Background: Background Recently, a real-time system, named cancer diagnostic probe (CDP), has been developed to diagnose the presence of pre-neoplastic/ neoplastic cells in breast cavity side margins. Detecting mechanism is real-time determination of the ROS/H 2 O 2 released from cancer or atypical cells, through reverse Warburg effect and hypoxia glycolysis pathways.Aims: Here, we designed a human model study based on real-time checking of 387 internal margins (IM) from 39 neoadjuvant breast cancer cases by CDP.Materials & Methods: Each lesion was checked by entered needle sensor and electrical scores were recorded. The permanent pathology result of each tested lesion was our gold standard to evaluate CDP scoring. CDP results were compared with permanent pathology of tumour side margins (as a conventional margin evaluation procedure).Results: Results showed that the sensitivity of CDP in scoring the cavity side margins of those cases is 91%. A total of 18 involved IM which had been detected by CDP were declared as free margins in pathology section of tumour side samples.Just five involved IM were missed by CDP.

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Accuracy of gross intraoperative margin assessment for breast cancer: experience since the SSO-ASTRO margin consensus guidelines

Cited by 31 publications

References 48 publications

Accuracy of frozen section in intraoperative margin assessment for breast-conserving surgery: A systematic review and meta-analysis

Accuracy of frozen section in intraoperative margin assessment for breast-conserving surgery: A systematic review and meta-analysis

Clinical practice guideline for breast-conserving surgery in patients with early-stage breast cancer: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021

Accuracy of cancer diagnostic probe for intra‐surgical checking of cavity side margins in neoadjuvant breast cancer cases: A human model study

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