Rapid Assessment of Resection Margins During Breast Conserving Surgery Using Intraoperative Flow Cytometry

Evaluation of tumor margin status during surgery is critical to avoid tumor recurrence. We compared intraoperative flow cytometry (iFC) with cytology and pathology in breast-conserving surgeries. Flow cytometry had greater sensitivity and similar specificity and accuracy compared with cytology. Our data support the utility of iFC for rapid evaluation of the excision margins of lumpectomies, thus improving the precision of breast-conserving surgeries. Background: Positive margins are the most important factor for recurrence of the disease after breast-conserving surgery. Several methods have been developed throughout the years to evaluate the margin status during surgery in an attempt to assist the surgeon in excising the whole tumor at once, a goal that has not yet been accomplished. Patients and Methods: In our study, we compared intraoperative flow cytometry (iFC) with cytology and pathology in order to evaluate 606 samples of margins and tumors corresponding to 99 patients with invasive ductal carcinoma of no special type and invasive lobular carcinoma obtained from breast-conserving surgeries. Results: Using the pathology as the gold standard, flow cytometry had 93.3% sensitivity, 92.4% specificity, and 92.5% accuracy. Cytology had 82.3% sensitivity, 94.6% specificity, and 94.2% accuracy. Conclusions: Our data support the suggestion that iFC is a novel, reliable technique that allows rapid evaluation of the excision margins of lumpectomies, thus improving the precision of breast-conserving surgery. Among the advantages of iFC are that it does not rely on the expertise of a pathologist or cytologist, it is low cost, and it has no additional psychological effect on patients, because no re-operation is needed.

Automated summary

Evaluating tumor margin status during surgery is critical to prevent tumor recurrence. Intraoperative flow cytometry (iFC) showed greater sensitivity and similar specificity and accuracy compared to cytology in breast-conserving surgeries. The data supports the utility of iFC for rapid evaluation of excision margins, improving the precision of breast-conserving surgeries.