术中评估乳房肿瘤切除标本的手术边缘的持续作用。

IF 1.9 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Breast Journal Pub Date : 2021-11-01 Epub Date: 2021-11-10 DOI:10.1111/tbj.14298
Shahla Masood
{"title":"术中评估乳房肿瘤切除标本的手术边缘的持续作用。","authors":"Shahla Masood","doi":"10.1111/tbj.14298","DOIUrl":null,"url":null,"abstract":"Currently, breast conservation therapy that includes removal of the primary tumor of the breast by lumpectomy followed by adjunct radiation is a preferred treatment for majority of breast cancer patients.1,2 This practice, however, requires the ability to obtain negative lumpectomy margins to balance between optimal local control of the tumor and minimal tissue resection.3 Obtaining clear surgical margins are found to be important for local control as positive surgical margins increase local recurrence rate by at least twofold.4– 6 Studies have demonstrated that as positive surgical margins are associated with higher rate of local recurrence and the need for a second return to the operating room for the reexcision of positive margins, measures should be in place to avoid this process. In addition, it is critically important to follow the established national guidelines in respect to the accepted definition of an adequate margin. Based on 2014, and 2016 consensus statements offered by the Society of Surgical Oncology and the American Society of Radiation Oncology, adequate surgical margin is defined as no tumor at ink for invasive breast cancer and a 2mm tumorfree margin adequate for ductal carcinoma in situ.7,8 In order to avoid a second surgery and the associated cost and anxiety to breast cancer patients undergoing lumpectomy, it is important to consider providing an intraoperative assessment of surgical margins. This requires an accurate and costeffective rapid intraoperative technique that would evaluate surgical margins and allow for realtime reexcision to be perform if necessary.9,10 There are two alternatives to provide an intraoperative consultation. The most traditional approach has been the frozen section analysis. This approach has shown to minimize reoperation rates.11– 17 In a recent study reported by Racz et al.,18 the use of intraoperative frozen section pathologic evaluation of margins in patients undergoing lumpectomy has resulted in an extremely low reoperation rate of <2%. Similarly, in the study reported by Akrami et al.19 published in the current issue of The Breast Journal, the authors report the low rate of 2.3% positive surgical margins among 4843 patients enrolled in this study. The authors attribute the low rate of the positive margins in their study to the use of the intraoperative frozen section consultation in their practice. There is, however, a trend that has made the use of intraoperative consultation by frozen sectioning less frequent with dependence only on the final permanent section diagnosis of surgical margins. This may be the result of frozen sections being considered labor intensive, expensive and technically difficult to freeze and cut adipose tissue.20– 22","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The continued role of intraoperative assessment of the surgical margins in lumpectomy samples.\",\"authors\":\"Shahla Masood\",\"doi\":\"10.1111/tbj.14298\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Currently, breast conservation therapy that includes removal of the primary tumor of the breast by lumpectomy followed by adjunct radiation is a preferred treatment for majority of breast cancer patients.1,2 This practice, however, requires the ability to obtain negative lumpectomy margins to balance between optimal local control of the tumor and minimal tissue resection.3 Obtaining clear surgical margins are found to be important for local control as positive surgical margins increase local recurrence rate by at least twofold.4– 6 Studies have demonstrated that as positive surgical margins are associated with higher rate of local recurrence and the need for a second return to the operating room for the reexcision of positive margins, measures should be in place to avoid this process. In addition, it is critically important to follow the established national guidelines in respect to the accepted definition of an adequate margin. Based on 2014, and 2016 consensus statements offered by the Society of Surgical Oncology and the American Society of Radiation Oncology, adequate surgical margin is defined as no tumor at ink for invasive breast cancer and a 2mm tumorfree margin adequate for ductal carcinoma in situ.7,8 In order to avoid a second surgery and the associated cost and anxiety to breast cancer patients undergoing lumpectomy, it is important to consider providing an intraoperative assessment of surgical margins. This requires an accurate and costeffective rapid intraoperative technique that would evaluate surgical margins and allow for realtime reexcision to be perform if necessary.9,10 There are two alternatives to provide an intraoperative consultation. The most traditional approach has been the frozen section analysis. This approach has shown to minimize reoperation rates.11– 17 In a recent study reported by Racz et al.,18 the use of intraoperative frozen section pathologic evaluation of margins in patients undergoing lumpectomy has resulted in an extremely low reoperation rate of <2%. Similarly, in the study reported by Akrami et al.19 published in the current issue of The Breast Journal, the authors report the low rate of 2.3% positive surgical margins among 4843 patients enrolled in this study. The authors attribute the low rate of the positive margins in their study to the use of the intraoperative frozen section consultation in their practice. There is, however, a trend that has made the use of intraoperative consultation by frozen sectioning less frequent with dependence only on the final permanent section diagnosis of surgical margins. This may be the result of frozen sections being considered labor intensive, expensive and technically difficult to freeze and cut adipose tissue.20– 22\",\"PeriodicalId\":56326,\"journal\":{\"name\":\"Breast Journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2021-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Breast Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/tbj.14298\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/11/10 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Breast Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/tbj.14298","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/11/10 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

本文章由计算机程序翻译,如有差异,请以英文原文为准。
The continued role of intraoperative assessment of the surgical margins in lumpectomy samples.
Currently, breast conservation therapy that includes removal of the primary tumor of the breast by lumpectomy followed by adjunct radiation is a preferred treatment for majority of breast cancer patients.1,2 This practice, however, requires the ability to obtain negative lumpectomy margins to balance between optimal local control of the tumor and minimal tissue resection.3 Obtaining clear surgical margins are found to be important for local control as positive surgical margins increase local recurrence rate by at least twofold.4– 6 Studies have demonstrated that as positive surgical margins are associated with higher rate of local recurrence and the need for a second return to the operating room for the reexcision of positive margins, measures should be in place to avoid this process. In addition, it is critically important to follow the established national guidelines in respect to the accepted definition of an adequate margin. Based on 2014, and 2016 consensus statements offered by the Society of Surgical Oncology and the American Society of Radiation Oncology, adequate surgical margin is defined as no tumor at ink for invasive breast cancer and a 2mm tumorfree margin adequate for ductal carcinoma in situ.7,8 In order to avoid a second surgery and the associated cost and anxiety to breast cancer patients undergoing lumpectomy, it is important to consider providing an intraoperative assessment of surgical margins. This requires an accurate and costeffective rapid intraoperative technique that would evaluate surgical margins and allow for realtime reexcision to be perform if necessary.9,10 There are two alternatives to provide an intraoperative consultation. The most traditional approach has been the frozen section analysis. This approach has shown to minimize reoperation rates.11– 17 In a recent study reported by Racz et al.,18 the use of intraoperative frozen section pathologic evaluation of margins in patients undergoing lumpectomy has resulted in an extremely low reoperation rate of <2%. Similarly, in the study reported by Akrami et al.19 published in the current issue of The Breast Journal, the authors report the low rate of 2.3% positive surgical margins among 4843 patients enrolled in this study. The authors attribute the low rate of the positive margins in their study to the use of the intraoperative frozen section consultation in their practice. There is, however, a trend that has made the use of intraoperative consultation by frozen sectioning less frequent with dependence only on the final permanent section diagnosis of surgical margins. This may be the result of frozen sections being considered labor intensive, expensive and technically difficult to freeze and cut adipose tissue.20– 22
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Breast Journal
Breast Journal 医学-妇产科学
CiteScore
4.00
自引率
0.00%
发文量
47
审稿时长
4-8 weeks
期刊介绍: The Breast Journal is the first comprehensive, multidisciplinary source devoted exclusively to all facets of research, diagnosis, and treatment of breast disease. The Breast Journal encompasses the latest news and technologies from the many medical specialties concerned with breast disease care in order to address the disease within the context of an integrated breast health care. This editorial philosophy recognizes the special social, sexual, and psychological considerations that distinguish cancer, and breast cancer in particular, from other serious diseases. Topics specifically within the scope of The Breast Journal include: Risk Factors Prevention Early Detection Diagnosis and Therapy Psychological Issues Quality of Life Biology of Breast Cancer.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信