Intra-operative analysis of lumpectomy margins: How effective and at what cost?

Abstract

Abstract Introduction: Breast conservation therapy (BCT) for Stage I-II breast cancer and DCIS requires obtaining tumor-free margins to prevent recurrence. Although assessing margins intra-operatively has not been widely accepted, the University of Florida (UF) has been performing frozen sections (FS) on margins of all patients undergoing BCT in an attempt to reduce the number of additional operation. This study reviews the effectiveness of this method and calculates the additional cost required. Methods: Operative and pathology reports and financial statements were retrospectively reviewed on 75 patients who had BCT between January 2001 and February 2003 at UF in Gainesville. Results: Of the 75 patients studied, 19 (25%) required an additional operation. Thirty-three had positive margins on paraffin embedded histological analysis. False-negatives occurred in 5% of all FS margins analyzed, affecting the operative pathway in 25% of the patients. False-positives occurred in 1% of all FS, affecting the pathway in one patient. The additional operative time was 13 minutes per case. The additional cost was $876.00 per case. Sixty-three (84%) patients had BCT and 12 patients (16%) required a modified radical mastectomy. Conclusions: Intra-operative analysis of margins using FS is effective at minimizing the number of additional operations. Of those patients who had positive margins on paraffin embedded histological analysis (33), 14 (42%) were successfully diagnosed by FS, ultimately preventing a second operation. The reduction in second operations combined with the minimal additional cost justifies our use of FS in assessing lumpectomy margins.