Intraoperative pathological monitorization of surgical margins: a method to reduce recurrences after conservative treatment for breast cancer

Introduction: Local recurrences after conservative surgical treatment for breast cancer are not uncommon and cause negative influences on the oncological prognosis and quality of life of the patients. Aiming to avoid this problem, we have developed a method of intraoperative pathological monitoring of surgical margins (IPMSM), in order to assure adequacy of resection.

Materials and methods: IPMSM is based on radiological. macroscopic, cytological and histological examination of frozen sections of the breast specimens in the operating room during the surgery. We evaluated 98 women with 100 tumors clinical stage I-II breast cancer for whom we planned conservative surgery. The margins were oriented by the surgeon and inked by the pathologist in different colors to retain orientation.

RESULTS AND DISCUSSSION: According to the histological or cytological results, immediate re-excision was indicated and performed in 40 (40.8%) cases. In six of these, we had to perform a mastectomy. The indications for additional resections were: insufficient margins in 23 cases, extensive intraductal component in eight, multifocality in four, atypical proliferative lesion at the margin in four and diffuse tumor in one. Permanent histological sections confirmed all intraoperative results. These patients were followed by a median period of 42 months (range 3 to 99 months) and we observed 1% of local recurrence and 5.1% of distant metastasis. We compared this group of patients with a control group represented by 149 cases of breast cancer stages I-II treated by conservative surgery, but not submitted to IPMSM. In the control group, we observed 17 (11.4%) local recurrences and 49 (32.9%) distant metastases after a follow-up period from 14 to 213 months (median of 126 months).

Conclusion: The IPMSM proved to be a safe and accurate method to prevent additional surgery for insufficient margins and to reduce the recurrence rate.

Breast cancer; Conservative surgery; Frozen section examination

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