Influencing Factors Of Positive Margins In Frozen Section Analysis During Breast Conserving Surgery

Objective: To retrospectively analyze the influencing factors of positive margins in frozen section analysis during breast conserving surgery to provide theoretical support for clinical practice,so as to improve the success rate of breast-conserving surgery.Methods: A total of 629 patients with breast-conserving surgery from 2014-8-1 to 2016-10-31 were collected for clinical and pathological data.Firstly,the univariate analysis of the relevant clinicopathological features that may affect the margin of breast-conserving surgery was performed,and the multi-factor analysis was carried out on the meaningful influencing factors,so that the independent influencing factors affecting the positive margin of breast-conserving surgery were obtained.In the first time of breast-conserving surgery,the factors affecting the number of positive margins were analyzed.RESULTS: Patients with positive margins in frozen section analysis during breast-conserving surgery were firstly analyzed by univariate analysis of relevant clinical and pathological data.Univariate analysis showed that FSA positive margin was significantly correlated with tumor distance from nipple(P=0.008),tumor distribution along the duct(P=0.004),pathological type subtype(P=0.011),lymph node metastasis(P<0.001),irrespective of age(P=0.974),menstrual status(P=0.483),family history of tumor(P=0.586),tumor location(P=0.121),MRI(P=0.699),molecular typing(P=0.114)),histological grade(P = 0.281),pathological T stage(P = 0.241).And multivariate analysis showed the distance from nipple(P= 0.030),tumor distribution along the duct(P<0.001),pathological type subtype(P=0.045)and lymph node metastasis(P<0.001)were independent factors affecting positive margins.Patients with positive margin were divided into four groups according to the initial number of positive sites: 1,2,3 and ? 4,and the factors that may affect the number of positive sites were analyzed: patients who was premenopausal(P=0.011)and has no mammary MRI(P=0.031)may have more positive sites than those who were postmenopausal and had checked breast MRI,there is nothing to do with whether there was a family history of tumor(P=0.356),lesions along the duct(P=0.828),pathological type(P=0.071),molecular typing(P=0.891),lymph node metastasis(P=0.409),histological grade(P =0.0690),tumor pathology T stage(P=0.082),distance from nipple(P=0.133),age(P=0.127).Conclusion: The closer the distance from the nipple,tumor distribution along the duct,pathological type subtype and lymph node metastasis are the independent factors of the positive margin.Patients in premenopausal status and with no breast MRI are more likely to have multiple positive sites.Therefore,patients who are scheduled for breast-conserving surgery are advised to evaluate the extent of tumor lesions by preoperative breast MRI.If the distance between the tumor and the nipple is closer,tumor distribution along the duct and the imaging indicates lymph node metastasis,the resection should be expanded during the breast conserving surgery which may avoid positive margin and therefore improve the success rate of breast conserving surgery as well as reduce the rate of reoperation.