Restricted accessResearch articleFirst published online 2026-1
A comparative evaluation of ultrasound and frozen section analysis in predicting margin status after breast conservation surgery in patients with ultrasound-detectable breast cancer
The primary goal of breast conservation surgery (BCS) is to achieve tumour-free margins. However, it is known that in 20% patients, a tumour-free margin may not be obtained. Positive margins frequently lead to re-operation and are the strongest predictors of local recurrence. We therefore evaluated the performance of ultrasound (US) and frozen section (FS) in predicting the margin status of lumpectomy specimens of ultrasound-detectable breast carcinoma patients undergoing BCS. In our prospective study on 54 patients who underwent lumpectomy, the margins were analyzed by ultrasound and frozen section. Patient-wise and margin-wise diagnostic parameters were calculated for both modalities.
LepomäkiMKarhunen-EnckellUTuominenJ, et al.Tumor margins that lead to reoperation in breast cancer: a retrospective register study of 4,489 patients. J Surg Oncol2022; 125: 577–588.
2.
VeronesiUCascinelliNMarianiL, et al.Twenty-Year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med2002; 347: 1227–1232.
3.
LichterASLippmanMEDanforthDN, et al.Mastectomy versus breast-conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the national cancer institute. J Clin Oncol1992; 10: 976–983.
4.
LitièreSWerutskyGFentimanIS, et al.Breast conserving therapy versus mastectomy for stage I–II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol2012; 13: 412–419.
5.
BalchGCMithaniSKSimpsonJF, et al.Accuracy of intraoperative gross examination of surgical margin status in women undergoing partial mastectomy for breast malignancy. Am Surg2005; 71: 22–27.
6.
JinMKimJYKimTH, et al.Intraoperative specimen mammography for margin assessment in breast-conserving surgery. J Breast Cancer2019; 22: 635–640.
7.
KrekelNMAHalouaMHLopes CardozoAMF, et al.Intraoperative ultrasound guidance for palpable breast cancer excision (COBALT trial): a multicentre, randomised controlled trial. Lancet Oncol2013; 14: 48–54.
8.
DavisKMHsuCHBoutonME, et al.Intraoperative ultrasound can decrease the re-excision lumpectomy rate in patients with palpable breast cancers. Am Surg2011; 77: 720–725.
9.
DoyleTEFactorREEllefsonCL, et al.High-frequency ultrasound for intraoperative margin assessments in breast conservation surgery: a feasibility study. BMC Cancer2011; 11: 444.
10.
D’HalluinFTasPRouquetteS, et al.Intra-operative touch preparation cytology following lumpectomy for breast cancer: a series of 400 procedures. Breast Edinb Scotl2009; 18: 248–253.
11.
OlsonTPHarterJMuñozA, et al.Frozen section analysis for intraoperative margin assessment during breast-conserving surgery results in low rates of re-excision and local recurrence. Ann Surg Oncol2007; 14: 2953–2960.
12.
RusbyJEParamanathanNLawsSAM, et al.Immediate latissimus dorsi miniflap volume replacement for partial mastectomy: use of intra-operative frozen sections to confirm negative margins. Am J Surg2008; 196: 512–518.
13.
FukamachiKIshidaTUsamiS, et al.Total-circumference intraoperative frozen section analysis reduces margin-positive rate in breast-conservation surgery. Jpn J Clin Oncol2010; 40: 513–520.
14.
JanssenNNYvan SeijenMLooCE, et al.Feasibility of micro-computed tomography imaging for direct assessment of surgical resection margins during breast-conserving surgery. J Surg Res2019; 241: 160–169.
15.
AgrestiRTrecateGFerrarisC, et al.Ex vivo MRI evaluation of breast tumors: a novel tool for verifying resection of nonpalpable only MRI detected lesions. Breast J2013; 19: 659–663.
16.
GökerMMarcinkowskiRVan BockstalM, et al.18F-FDG micro-PET/CT for intra-operative margin assessment during breast-conserving surgery. Acta Chir Belg2020; 120: 366–374.
17.
HaRFriedlanderLCHibshooshH, et al.Optical coherence tomography: a novel imaging method for post-lumpectomy breast margin assessment-A multi-reader study. Acad Radiol2018; 25: 279–287.
18.
SchnabelFBoolbolSKGittlemanM, et al.A randomized prospective study of lumpectomy margin assessment with use of MarginProbe in patients with nonpalpable breast malignancies. Ann Surg Oncol2014; 21: 1589–1595.
19.
DixonJMRenshawLYoungO, et al.Intra-operative assessment of excised breast tumour margins using ClearEdge imaging device. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol2016; 42: 1834–1840.
20.
ThomasGNguyenTQPenceIJ, et al.Evaluating feasibility of an automated 3-dimensional scanner using Raman spectroscopy for intraoperative breast margin assessment. Sci Rep2017; 7: 13548.
21.
WongTTWZhangRHaiP, et al.Fast label-free multilayered histology-like imaging of human breast cancer by photoacoustic microscopy. Sci Adv2017; 3: e1602168.
22.
TrevethanR. Sensitivity, specificity, and predictive values: foundations, pliabilities, and pitfalls in research and practice. Front Public Health2017; 5: 307.
23.
St JohnERAl-KhudairiRAshrafianH, et al.Diagnostic accuracy of intraoperative techniques for margin assessment in breast cancer surgery: a meta-analysis. Ann Surg2017; 265: 300–310.
24.
Butler-HendersonKLeeAHPriceRI, et al.Intraoperative assessment of margins in breast conserving therapy: a systematic review. Breast Edinb Scotl2014; 23: 112–119.
25.
BarelliniLMarcascianoMLo TortoF, et al.Intraoperative ultrasound and oncoplastic combined approach: an additional tool for the oncoplastic surgeon to obtain tumor-free margins in breast conservative surgery-A 2-year single-center prospective study. Clin Breast Cancer2020; 20: e290–e294.
26.
ChakedisJMTangAKuehnerGE, et al.Implementation of intraoperative ultrasound localization for breast-conserving surgery in a large, integrated health care system is feasible and effective. Ann Surg Oncol2021; 28: 5648–5656.
27.
PereraNBourkeAG. The technique and accuracy of breast specimen ultrasound in achieving clear margins in breast conserving surgery. J Med Imaging Radiat Oncol2020; 64: 747–755.
28.
KumarNTandonMChintamaniC. Intraoperative specimen ultrasonography: is it a reliable tool for margin assessment following breast conservation surgery for breast carcinoma?Cureus2021; 13: e15806.
29.
OlshaOShemeshDCarmonM, et al.Resection margins in ultrasound-guided breast-conserving surgery. Ann Surg Oncol2011; 18: 447–452.
30.
RamosMDíazJCRamosT, et al.Ultrasound-guided excision combined with intraoperative assessment of gross macroscopic margins decreases the rate of reoperations for non-palpable invasive breast cancer. Breast Edinb Scotl2013; 22: 520–524.
31.
RamosMDíezJCRamosT, et al.Intraoperative ultrasound in conservative surgery for non-palpable breast cancer after neoadjuvant chemotherapy. Int J Surg Lond Engl2014; 12: 572–577.
