scholarly journals The Efficacy of Intraoperative Frozen Section Analysis during Breast-Conserving Surgery for Patients with Ductal Carcinoma in Situ

2016 ◽  
Vol 10 ◽  
pp. BCBCR.S40868 ◽  
Author(s):  
Mi Jin Kim ◽  
Cheol Seung Kim ◽  
Young Sam Park ◽  
Eun Hye Choi ◽  
Kyu Dam Han
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Frozen Section ◽  
Breast Conserving Surgery ◽  
Resection Margins ◽  
Intraoperative Frozen Section ◽  
Frozen Section Analysis ◽  
Section Analysis

Introduction Recently, the incidence of ductal carcinoma in situ (DCIS), a noninvasive breast malignancy, has increased. This has resulted in an increase in the incidence of breast-conserving surgery (BCS). Numerous studies have suggested that intraoperative frozen section analysis (IFSA) could reduce the rate of additional excisions required to obtain adequate resection margins. However, DCIS is a known risk factor for positive margin status during BCS. Furthermore, some authors have concluded that IFSA may not be reliable for the detection of DCIS. Aim The aim of this study was to evaluate the safety and efficacy of IFSA in patients with DCIS. Methods The operative and pathological reports of patients with DCIS, who underwent BCS at our institute between 2006 and 2015, were retrospectively reviewed. The results of IFSA and the pathological findings of final reanalyzed frozen tissue specimens were analyzed. Results In total, 25 patients were included in our analysis. None of the patients required additional operations. The correct diagnosis rate for IFSA was 89.6%, with a sensitivity and specificity of 60.0% and 95.8%, respectively. Conclusion IFSA could be beneficial for determining safety resection margins in patients with DCIS.

scholarly journals Value of intraoperative frozen section analysis in re-excision margin evaluation in breast-conserving surgery for cancer: a single institution experience

2020 ◽  
Author(s):  
Jian Guo Shen ◽  
Lin Bo Wang ◽  
Zi Nong Jiang ◽  
Xiao Ming Yuan ◽  
Wen He Zhao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Frozen Section ◽  
Positive Margin ◽  
Breast Conserving Surgery ◽  
Histological Type ◽  
Intraoperative Frozen Section ◽  
Excision Margin ◽  
Frozen Section Analysis ◽  
Section Analysis

Abstract Background. Previous studies have demonstrated that in women with breast cancer treated with breast-conserving surgery (BCS), intraoperative frozen section analysis of lumpectomy margins results in a decrease in reoperation rates for margin control. However, the value of intraoperative frozen margin evaluation (FME) in re-excision margin analysis is not fully understood. We analyzed our breast cancer database to identify the value of intraoperative frozen section examination of specimens additionally resected prior to BCS. Methods. We conducted a retrospective review of patients who underwent attempted BCS for breast cancer with routine intraoperative FME at our institution between January 1998 and May 2016. The number of FMEs was analyzed. We additionally analyzed factors associated with positive re-excised margins to identify correlations with patient characteristics. Results. Of the 760 patients who underwent attempted BCS with routinely conducted intraoperative FME, frozen sections were obtained from the initial margin only in 82.5% (n=627), the initial margin as well as a one-time re-excision analysis in 15.8% (n=120), or the initial margin and two or more re-excision analyses in 1.7% (n-13). Based on the results of FME, 727 (95.6%) of the patients underwent BCS, while the remaining 33 (4.4%) converted to mastectomy. Among the patients who underwent BCS, 112 (15.4%) had an initial positive margin on a FME, underwent one-time margin re-excision and achieved a margin-free status, while 1.6% underwent a second margin resection due to a positive result on the first re-excised margin. In total, 72.7% of the conversions to mastectomy were due to a positive initial margin. Univariate and multivariate analyses showed that patients with the ductal carcinoma in situ (DCIS) histological type were more likely to have repeatedly positive re-excised margins during BCS. Conclusion. While routine intraoperative FME of re-excised margins provided only limited value in patients who underwent attempted BCS, this method may be beneficial in the subgroup of patients with the DCIS histological type.

scholarly journals Impact of consensus guidelines for breast‐conserving surgery in patients with ductal carcinoma in situ

2021 ◽  
Author(s):  
Abigail Tremelling ◽  
Rebecca L. Aft ◽  
Amy E. Cyr ◽  
William E. Gillanders ◽  
Katherine Glover‐Collins ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Consensus Guidelines

scholarly journals Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

2021 ◽  
Author(s):  
Carlos Canelo-Aybar ◽  
Alvaro Taype-Rondan ◽  
Jessica Hanae Zafra-Tanaka ◽  
David Rigau ◽  
Axel Graewingholt ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Surgical Outcomes ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Cochrane Library ◽  
Treatment Change ◽  
The Impact

Abstract Objective To evaluate the impact of preoperative MRI in the management of Ductal carcinoma in situ (DCIS). Methods We searched the PubMed, EMBASE and Cochrane Library databases to identify randomised clinical trials (RCTs) or cohort studies assessing the impact of preoperative breast MRI in surgical outcomes, treatment change or loco-regional recurrence. We provided pooled estimates for odds ratios (OR), relative risks (RR) and proportions and assessed the certainty of the evidence using the GRADE approach. Results We included 3 RCTs and 23 observational cohorts, corresponding to 20,415 patients. For initial breast-conserving surgery (BCS), the RCTs showed that MRI may result in little to no difference (RR 0.95, 95% CI 0.90 to 1.00) (low certainty); observational studies showed that MRI may have no difference in the odds of re-operation after BCS (OR 0.96; 95% CI 0.36 to 2.61) (low certainty); and uncertain evidence from RCTs suggests little to no difference with respect to total mastectomy rate (RR 0.91; 95% CI 0.65 to 1.27) (very low certainty). We also found that MRI may change the initial treatment plans in 17% (95% CI 12 to 24%) of cases, but with little to no effect on locoregional recurrence (aHR = 1.18; 95% CI 0.79 to 1.76) (very low certainty). Conclusion We found evidence of low to very low certainty which may suggest there is no improvement of surgical outcomes with pre-operative MRI assessment of women with DCIS lesions. There is a need for large rigorously conducted RCTs to evaluate the role of preoperative MRI in this population. Key Points • Evidence of low to very low certainty may suggest there is no improvement in surgical outcomes with pre-operative MRI. • There is a need for large rigorously conducted RCTs evaluating the role of preoperative MRI to improve treatment planning for DCIS.

scholarly journals Patterns of invasive recurrence among patients originally treated for ductal carcinoma in situ by breast-conserving surgery versus mastectomy

2021 ◽  
Vol 186 (3) ◽  
pp. 617-624
Author(s):  
Kate R. Pawloski ◽  
Audree B. Tadros ◽  
Varadan Sevilimedu ◽  
Ashley Newman ◽  
Lori Gentile ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Advanced Disease ◽  
Breast Conserving Surgery ◽  
Risk Profile ◽  
High Grade ◽  
Group A ◽  
First Recurrence

Abstract Purpose Local recurrence after treatment of ductal carcinoma in situ (DCIS) with breast-conserving surgery (BCS) is more common than after mastectomy, but it is unclear if patterns of invasive recurrence vary by initial surgical therapy. Among patients with invasive recurrence after treatment for DCIS, we compared patterns of first recurrence between those originally treated with BCS vs. mastectomy. Methods From 2000 to 2016, women with an invasive recurrence occurring ≥ 6 months after initial treatment for DCIS were retrospectively identified. Clinicopathologic features and adjuvant treatment of the initial DCIS, as well as characteristics of first invasive recurrences, were compared between patients who had undergone BCS vs. mastectomy. Results 452 patients with an invasive recurrence after surgery for DCIS were identified: 367 patients (81%) had initially undergone BCS and 85 patients (19%) mastectomy. Patients originally treated with mastectomy were younger and were more likely to have had high grade, necrosis, and multifocal or multicentric DCIS (p < 0.001) compared with the BCS group. A higher proportion of invasive recurrences were local after BCS (93%; 343/367), whereas 88% (75/85) of recurrences after mastectomy were regional or distant (p < 0.001). The median time to first invasive recurrence was not different between surgical groups (BCS: 6.4 years vs. mastectomy: 5.5 years; p = 0.12). Conclusions Among women who experienced a first invasive recurrence after treatment for DCIS, those who had originally undergone mastectomy more commonly presented with advanced disease compared to those treated with BCS, likely related to the absence of the breast and the higher risk profile of their initial DCIS.

scholarly journals Ductal Carcinoma In Situ of the Breast

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Richard J. Lee ◽  
Laura A. Vallow ◽  
Sarah A. McLaughlin ◽  
Katherine S. Tzou ◽  
Stephanie L. Hines ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Treatment Options ◽  
Breast Conserving Surgery ◽  
Partial Breast Irradiation ◽  
Significant Shift

Ductal carcinoma in situ (DCIS) of the breast represents a complex, heterogeneous pathologic condition in which malignant epithelial cells are confined within the ducts of the breast without evidence of invasion. The increased use of screening mammography has led to a significant shift in the diagnosis of DCIS, accounting for approximately 27% of all newly diagnosed cases of breast cancer in 2011, with an overall increase in incidence. As the incidence of DCIS increases, the treatment options continue to evolve. Consistent pathologic evaluation is crucial in optimizing treatment recommendations. Surgical treatment options include breast-conserving surgery (BCS) and mastectomy. Postoperative radiation therapy in combination with breast-conserving surgery is considered the standard of care with demonstrated decrease in local recurrence with the addition of radiation therapy. The role of endocrine therapy is currently being evaluated. The optimization of diagnostic imaging, treatment with regard to pathological risk assessment, and the role of partial breast irradiation continue to evolve.

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