Abstract
The most important parameter for local recurrence after breast-conserving surgery (BCS) to treat breast cancer is surgical margin negativity. Hence, intraoperative assessment of the surgical margins (IASM) of the breast excisions is usually requested. There are still some clinical settings in which the pathologist will also perform intraoperative sentinel lymph node (SLN) examination. Depending on the pathologist’s experience and conditions, the method is typically either frozen section (FS) or cytology in addition to gross examination, although some molecular techniques have recently been developed for intraoperative pathological examination (IPE).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Fessia L, Ghiringhello B, Arisio R, Botta G, Aimone V. Accuracy of frozen section diagnosis in breast cancer detection: a review 4436 biopsies and comparison with cytodiagnosis. Pathol Res Pract. 1984;179:61–6.
Kaufman Z, Lew S, Griffel B, Dinbar A. Frozen-section diagnosis in surgical pathology. A prospective analysis of 526 frozen sections. Cancer. 1986;57:377–9.
Esteban JM, Zaloudek C, Silverberg SG. Intraoperative diagnosis of breast lesions. Comparison of cytologic with frozen section technics. Am J Clin Pathol. 1987;88:681–8.
De Rosa G, Boschi R, Boscaino A, Petrella G, Vetrani A, Palombini R, et al. Intraoperative cytology in breast cancer diagnosis: comparison between cytologic and frozen section techniques. Diagn Cytopathol. 1993;9:623–31.
Veneti S, Ioannidou-Mouzaka L, Toufexi H, Xenitides J, Anastasiadis P. Imprint cytology. A rapid, reliable method of diagnosing breast malignancy. Acta Cytol. 1996;40:649–52.
Spivack B, Khanna MM, Tafra L, Juillard G, Giuliano AE. Margin status and local recurrence after breast-conserving surgery. Arch Surg. 1994;138:1371–4.
Graham RA, Homer MJ, Katz J, Rothschild J, Safaii H, Supran S. The pancake phenomenon contributes to inaccuracy of margin assessment in patients with breast cancer. Am J Surg. 2002;184:89–93.
Barthelmes L, Al Awa A, Crawford DJ. Effects of cavity margin shavings to ensure completeness of excision on local recurrence rates following breast conserving therapy. Eur J Surg Oncol. 2003;29:644–8.
Cao D, Lin C, Woo SH, Vang R, Tsangaris TN, Argani P. Separate cavity margin sampling at the time of initial breast lumpectomy significantly reduces the need for reexcisions. Am J Surg Pathol. 2005;29:1625–32.
Guidi AJ, Connoly JL, Harris JR, Schnitt SJ. The relationship between shaved margin and inked margin status in breast excision specimens. Cancer. 1997;70:1568–73.
Rubin P, O’Honlon D, Browell D, Callanan K, Shrimankar J, Scott D, et al. Tumour bed biopsy detects the presence of multifocal disease in patients undergoing breast conservation therapy for primary breast carcinoma. Eur J Surg Oncol. 1996;22:23–6.
Riedl O, Fitzal F, Mader N, Dubsky P, Rudas M, Mittlboeck M, et al. Intraoperative frozen section analysis for breast-conserving therapy in 1016 patients with breast cancer. Eur J Surg Oncol. 2009;35:264–70.
Olson TP, Harter J, Munoz A, Mahvi DM, Breslin T. Frozen section analysis for intraoperative margin assessment during breast-conserving surgery results in low rates of re-excision and local recurrence. Ann Surg Oncol. 2007;14:2953–60.
Camp ER, McAuliffe PF, Gilroy JS, Morris CG, Lind DS, Mendenhall NP, et al. Minimizing local recurrence after breast conserving therapy using intraoperative shaved margins to determine pathologic tumor clearance. J Am Coll Surg. 2005;201:855–61.
Bakhshandeh M, Tutuncuoglu SO, Fischer G, Masood S. Use of imprint cytology for assessment of surgical margins in lumpectomy specimens of breast cancer patients. Diagn Cytopathol. 2007;35:656–9.
Klimberg VS, Westbrook KC, Korourian S. Use of touch preps for diagnosis and evaluation of surgical margins in breast cancer. Ann Surg Oncol. 1998;5:220–6.
Valdes EK, Boolbol SK, Ali I, Feldman SM, Cohen JM. Intraperative touch preparation cytology for margin assessment in breast-conservation surgery: does it work for lobular carcinoma? Ann Surg Oncol. 2007;14:2940–5.
St John ER, Al-Khudairi R, Ashrafian H, Athanasiou T, Takats Z, Hadjiminas DJ, et al. Diagnostic accuracy of intraoperative techniques for margin assessment in breast cancer surgery: a meta-analysis. Ann Surg. 2017;265:300–10.
Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis. A randomized clinical trial. JAMA. 2011;305:569–75.
Giuliano AE, Ballman KV, McCall L, Beitsch PD, Brennan MB, Kelemen PR, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA. 2017;318:918–26.
Tew K, Irwig L, Matthews A, Crowe P, Macaskill P. Metaanalysis of sentinel lypmh node cytology in breast cancer. Br J Surg. 2005;92:1068–80.
Liu LC, Lang JE, Lu Y, Roe D, Hwang SE, Ewing CA, et al. Intraoperative frozen section analysis of sentinel lymph nodes in breast cancer patients. A meta-analysis and single-institution experience. Cancer. 2011;117:250–8.
Fung V, Kohlhardt S, Vergani P, Zardin GJ, Williams NR. Intraoperative prediction of the two axillary lymph node macrometastases threshold in patients with breast cancer using a one-step nucleic acid cytokeratin-19 amplification assay. Mol Clin Oncol. 2017;7:755–62.
Shigematsu H, Ozaki S, Yasui D, Zaitsu J, Taniyama D, Saitou A, et al. Comparison of CK-IHC assay on serial frozen sections, the OSNA assay, and in combination for intraoperative evaluation of SLN metastases in breast cancer. Breast Cancer. 2017;25(2):191–7. https://doi.org/10.1007/s12282-017-0811-y.
Lyman GH, Giuliano AE, Somerfield MR, Benson AB, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23:7703–20.
Fitzgibbons PL, Page DL, Weaver D, Thor AD, Allred DC, Clark GM, et al. Prognostic factors in breast cancer: College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med. 2000;124:966–78.
Association of Directors of Anatomic and Surgical Pathology. Recommendations for processing and reporting of lymph node specimens submitted for evaluation of metastatic disease. Am J Clin Pathol. 2001;115:799–801.
Turner RR. Histopathologic processing of the sentinel lymph node. Semin Breast Dis. 2002;5:35–40.
Weaver DL, Krag DN, Ashikaga T, Harlow SP, O’Connell M. Pathologic analysis of sentinel and nonsentinel lymph nodes in breast carcinoma: a multicenter study. Cancer. 2000;88:1099–107.
Cserni G. Metastases in axillary sentinel lymph nodes in breast cancer as detected by intensive histopathological work up. J Clin Pathol. 1999;52:922–4.
Turner RR, Ollila DW, Stern S, Giuliano AE. Optimal histopathologic examination of the sentinel lymph node for breast carcinoma staging. Am J Surg Pathol. 1999;23:263–7.
Zhang PJ, Reisner RM, Nangia R, Edge SB, Brooks JJ. Effectiveness of multiple-level sectioning in detecting axillary nodal micrometastasis in breast cancer: a retrospective study with immunohistochemical analysis. Arch Pathol Lab Med. 1998;122:687–90.
Weaver DL, Le UP, Dupuis SL, Weaver KA, Harlow SP, Ashikaga T, et al. Metastasis detection in sentinel lymph nodes: comparison of a limited widely spaced (NSABP Protocol B-32) and a comprehensive narrowly spaced paraffin block sectioning strategy. Am J Surg Pathol. 2009;33:1583–9.
Kollias J, Gil PG, Chatterton B, Raymond W, Collins PJ. Sentinel node biopsy in breast cancer: recommendations for surgeons, pathologists, nuclear physicians and radiologists in Australia and New Zeeland. Aust N Z J Surg. 2000;70:132–6.
Cserni G, Amendoeira I, Apostolikas N, Bellocq JP, Bianchi S, Boecker W, et al. Discrepansies in current practice of pathological evaluation of sentinel lymph nodes in breast cancer. Results of a questionnaire-based survey by the European Working Group for Breast Screening Pathology. J Clin Pathol. 2004;57:695–701.
Green FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, et al. AJCC Cancer staging manual. 6th ed. New York: Springer; 2002.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Yavuz, E., Tuzlali, S. (2019). Intraoperative Pathological Examination of Breast Lesions. In: Aydiner, A., Igci, A., Soran, A. (eds) Breast Cancer . Springer, Cham. https://doi.org/10.1007/978-3-319-96947-3_5
Download citation
DOI: https://doi.org/10.1007/978-3-319-96947-3_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-96946-6
Online ISBN: 978-3-319-96947-3
eBook Packages: MedicineMedicine (R0)