Margins That Matter: Intraoperative Frozen Section Analysis to Reduce Positive Resection Margins in Breast-Conserving Surgery

Louis Martin¹, Lukas Weber², Oliver Bennett³

Abstract

Background:
Positive surgical margins in breast-conserving surgery (BCS) are associated with increased risk of local recurrence and the need for reoperation. Intraoperative frozen section analysis (IFSA) offers a real-time method to guide margin clearance, but its routine adoption remains inconsistent.

Objective:
To evaluate the impact of implementing routine IFSA on the rate of positive margins and reoperations in patients undergoing BCS for early-stage breast cancer.

Methods:
A prospective interventional study was conducted in two tertiary surgical centers in Germany between January 2022 and December 2023. A total of 482 patients undergoing BCS were included—241 before IFSA implementation (control) and 241 after (intervention). Positive margins were defined as tumor cells at the inked resection margin. Secondary outcomes included reoperation rates and operative time.

Results:
The positive margin rate decreased from 18.7% in the control group to 6.6% in the intervention group (p < 0.001). Reoperation rates dropped from 14.5% to 4.5% (p < 0.001). Mean operative time increased by 19 minutes (p = 0.02) in the IFSA group. The accuracy of IFSA was high, with sensitivity of 91.4% and specificity of 98.2%.

Conclusion:
Routine use of IFSA in BCS significantly reduces the rate of positive margins and reoperations, with only a modest increase in operative time. Surgical units should consider integrating IFSA into standard protocols for early-stage breast cancer.