Clinical significance of intraoperative histological examination of resection margins during organ-preserving operations

Introduction. Today, resection margins are assessed in different ways, but in clinical practice, preference is given to the histological method with macro- and microscopic examination of the margins. Assessment of resection margins can be carried out not only during planned histological examination, but also during intraoperative examination.

Aim. To evaluate the feasibility of intraoperative assessment of resection margins when performing organ-preserving operations in patients with primary resectable breast cancer.

Materials and methods. A retrospective study analyzed data from patients with early breast cancer who underwent surgical treatment at the Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia from June 2020 to May 2022. All patients underwent mammary gland resection with or without intraoperative marginal GI of resection, with sentinel lymph node determination or regional lymphadenectomy at the first stage. Patients included in the final analysis were divided into 2 groups: the study group consisted of patients who underwent intraoperative marginal GI of resection, and the control group consisted of patients who did not undergo intraoperative marginal GI of resection. Marginal GI of resection is performed by a pathologist by measuring the distance from the tumor node to the resection margins on a macropreparation. Frozen sections were always stained with hematoxylin and eosin.

Results. The 451 patients with early forms of breast cancer included in the final analysis and subjected to breast resection at the first stage were divided into 2 main groups: the study group consisted of patients (n = 310) who underwent intraoperative microscopic histological assessment of resection margins, and the control group included patients (n = 141) who did not undergo intraoperative assessment of resection margins. During intraoperative histological assessment of resection margins, patients with positive resection margins were most often observed with invasive cancer – 20.3 versus 3.9 % with intraductal cancer.

Conclusion. Further research is needed to determine the factors influencing the increase in the incidence of positive resection margins and their impact on patient survival rates.