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Beyond Frozen Section: Evolving Methodologies for Intraoperative Assessment of Surgical Margins in Breast

Ayesha Ahmed1

  • 1Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University and King Fahd Hospital of the University, Dammam, Kingdom of Saudi Arabia.

APMIS : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica
|December 15, 2025
PubMed
Summary

Accurate intraoperative margin evaluation is crucial for breast cancer surgery. This review explores advanced techniques beyond frozen sections to improve margin assessment and reduce local recurrence.

Keywords:
breast cancerevolving methodologiesfrozen sectionmargin clearance

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Area of Science:

  • Oncology
  • Surgical Pathology
  • Medical Imaging

Background:

  • Intraoperative margin evaluation is critical for breast-conserving surgery to prevent local recurrence.
  • Microscopic margin involvement significantly increases the risk of local recurrence.
  • Current standard, frozen section, has limitations including cost, time, technical challenges, and tissue consumption.

Purpose of the Study:

  • To define free margins in breast cancer surgery.
  • To review current histological methods for intraoperative margin evaluation.
  • To explore novel and evolving methodologies for enhanced intraoperative margin assessment.

Main Methods:

  • Review of existing literature on intraoperative margin evaluation techniques.
  • Discussion of traditional methods like frozen section.
  • Exploration of advanced techniques including touch preparation cytology, margin probes, flow cytometry, optical coherence tomography (OCT), and various advanced imaging modalities.

Main Results:

  • Frozen section, while common, presents significant limitations impacting diagnostic accuracy and workflow.
  • Emerging techniques offer potential to complement or replace frozen section for improved accuracy and efficiency.
  • Advanced methods like OCT and multimodal imaging show promise for real-time margin assessment.

Conclusions:

  • Accurate intraoperative margin assessment is vital for successful breast-conserving therapy.
  • Novel techniques are emerging to overcome the limitations of frozen section.
  • Further research and standardization of advanced methods are needed for widespread clinical adoption.