Intra-operative assessment of excision margins using breast imprint and scrape cytology

Muttalib, Masoom; Tai, C. C.; Briant-Evans, Toby; Maheswaran, Ian; Livni, Naomi; Shousha, Sami; Sinnett, H. D.

doi:10.1016/j.breast.2004.10.002

Cited by 23 publications

(12 citation statements)

References 29 publications

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“…Fisher et al showed that the technique of India ink staining as the method of margin assessment appeared to underestimate the true incidence of residual disease after lumpectomy, as the local recurrence rates were high in this trial (10). Study by Muttalib et al evaluated breast ISC for the assessment of excision margins and concluded that intra-operative ISC is feasible as a rapid and inexpensive technique and may correlate with clinical outcome (12). Imprint cytology has the advantage of speed, sparing of tissue for other studies and more complete sampling of large specimens (13).…”

Section: Methods To Assess Completeness Of Excisionmentioning

confidence: 90%

Effect of Cavity Shaving on Reoperation Rate Following Breast-Conserving Surgery

et al. 2008

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Breast-conserving surgery (BCS) without adequate margin clearance carries a high risk of local recurrence. We introduced cavity shaving at primary surgery 31 months ago, to assess tumor margin involvement. The aim of this study was to determine how cavity shaving affects the re-excision rate. We compared a group of 394 patients who underwent BCS with cavity shaving of macroscopically clear margins at primary operation, from March 2003 to September 2005 with a group of 392 patients who underwent BCS only from January 2000 to February 2003. Cavity shaves and re-excision specimens were measured and oriented with reference to the primary cancer. Pathological results of all the specimens were analyzed and re-excision rates in both groups were recorded. Compared with BCS alone where 49 of 392 patients (12.5%) required reoperation for margin clearance, only 22 of 394 patients (5.58%) of the group who had concurrent cavity shaves required further surgery (p < 0.01). Analysis of re-excised specimens suggests that reoperation could have been avoided in 44 of 49 patients, if they had standard sized cavity shave at primary operation. We conclude that cavity shavings during primary BCS significantly reduce the re-excision rate to ensure microscopic clearance.

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Section: Methods To Assess Completeness Of Excisionmentioning

confidence: 90%

Effect of Cavity Shaving on Reoperation Rate Following Breast-Conserving Surgery

et al. 2008

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“…Touch prep cytology has been offered by many authors for intraoperative evaluation of tumor margins (10,27,28). Sensitivity ranges from 80% to 100%, and specificity ranges from 85% to 100% (10,26,27).…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Frozen Section for Margin Assessment in Breast Conserving Surgery

et al. 2009

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Background and Aims: When excisional biopsy or lumpectomy is performed without margin assessment in early breast cancer,further surgery are required if positive margins exist. We evaluated the role of the intraoperative frozen section in breast conserving surgery (BCS). Clinicopathologic factors associated with re-excision were searched.Material and Methods: 190 tumors in 186 patients with early invasive breast cancer treated by BCS. Breast tumor was excised with 2c mm acroscopic margin, and microscopic margins examined by intraoperative frozen section.Results: After frozen section, 160 cases had negative margins (no re-excision), but 30 patients (16%) underwent re-excision because of close/positive margins. Negative margins were obtained in 24 patients but six patients underwent mastectomy due to persistent involved margins. Local recurrence was 2.1% and systemic recurrence was 2.6% with mean 62 months follow-up. Tu mor type, tumor size, extranodal extension and extensive intraductal component were significant predictors of re-excision by multivariate analysis. Re-excision procedures haven'tanimpact on local recurrence.Conclusions: Intraoperative frozen section is an effective procedure in reducing the need of second operation. We have observed lower recurrence rates than other studies because of our 2cmmacroscopic margin width and >2mmmicroscopic negative margin which obtained by intraoperative frozen section.

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“…Cytology has been recognized as a time and cost efficient method for intraoperative evaluation of lymph nodes and tissues in various surgical fields. In intraoperative evaluation of lymph nodes in breast cancer [4][5][6], the sensitivity ranges from 77-100% for macrometastases. It is considered a safe method for the evaluation of excision margins in lumpectomies [7,8], though Florell in a study of 58 patients with breast basal cell carcinoma (BCC) found the sensitivity of touch smear for identifying a positive margin to be only 50% and the specificity approximately 90% for all BCC types [9].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Cytological Evaluation of Marjolin Ulcers

et al. 2006

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Background: Marjolin ulcers are malignant neoplasia developing in chronic open wounds and pathological scars. A definitive diagnosis is made by histological examination of permanent sections. Frozen section biopsy has been widely used for intraoperative diagnosis and evaluation of surgical excision safety margins. This preliminary study aims to discuss the reliability of a simpler and faster method - intraoperative cytology - in the diagnosis of Marjolin ulcers. Patients and Methods: Touch or scrape smears of 76 Marjolin ulcers from 22 patients were assessed, and features were compared to the histological appearance of permanent sections. Results: Cytology revealed squamous cell carcinoma (SCC) in 45 ulcers from 11 patients. Histology confirmed SCC in 48 ulcers from 12 patients. No false-positive and one falsenegative results were found. Cytology was found to have a 98.7% accuracy, 98% sensitivity and 100% specificity in the intraoperative diagnosis of Marjolin ulcers. Conclusions: Cytology is a fast and reliable alternative in the intraoperative diagnosis of Marjolin ulcers.

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Intra-operative assessment of excision margins using breast imprint and scrape cytology

Cited by 23 publications

References 29 publications

Effect of Cavity Shaving on Reoperation Rate Following Breast-Conserving Surgery

Effect of Cavity Shaving on Reoperation Rate Following Breast-Conserving Surgery

Intraoperative Frozen Section for Margin Assessment in Breast Conserving Surgery

Intraoperative Cytological Evaluation of Marjolin Ulcers

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