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    • Margins in Breast Conserving Surgery: Could We Have Alternatives

    Sherif M. Mokhtar1 , Shady Elghazaly Harb1 , Hossam Hussein2 ,Shady Nabil Mashhour3
    1General Surgery Department; 2Pathology Department; 3Diagnostic& Interventional Radiology Department, Faculty of Medicine, Cairo University

    Background: For patients with breast cancer, a negative surgical margin at first breast conserving surgery (BCS) minimizes the need for reoperation and likely reduces postoperative anxiety. We assessed margin status after BCS in early-stage breast cancer. Aim of work: This study was conducted to evaluate the selfreported practice patterns and perceptions of obtaining free surgical margins in BCS in our university hospital. It is about alternatives of assessment of safe margins (gross, microscopic) and how safe it is not to depend entirely on frozen section intraoperatively, through studying the rate of wider margins after both ways. Methods: A prospective, randomized study (card picking by the patient under supervision of the ward nurse) of 103 female patients underwent breast-conserving surgery (BCS) with and without frozen section- 49 and 54 patients respectively - for assessment of margins intraoperatively were studied at General Surgery Department, kasr Alainy University hospital, Faculty of Medicine, Cairo University in a period of 21 months duration starting from January 1st, 2015 till October 31st, 2016. Results: Thirty eight patients out of total 54 (70.4%), who were randomized not to undergo frozen section for margins evaluation, were deemed to have clear margins on gross assessment and did not undergo re-excision for residual tumor which is confirmed on subsequent microscopic examination (paraffin section).While 16 females of the same group (29.6%) were found to have compromised margin(s) necessitating a second operation based on microscopic examination (paraffin section).On the other hand, ten patients out of 49 (20.4%), who were randomized to undergo frozen section for margins evaluation, underwent re-excision in order to have adequate safe margins in cases subjected to frozen section assessment of margins intraoperatively. Conclusion: Intraoperative gross assessment of margins depending on the type of margins excision is an effective technique to obtain safe margins in BCS with rates of re-excision near to cases subjected to frozen section for margins assessment intraoperatively. This is particularly useful in situations where frozen section technique is not available or represents added cost. Key words: breast conserving surgery, safe margins, gross assessment, frozen section.

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