J Korean Med Sci.  2023 Jul;38(30):e224. 10.3346/jkms.2023.38.e224.

Frozen Sections in Decision-Making Regarding the Axillary Procedures in Breast Conserving Surgery for Intraductal Carcinoma at Preoperative Diagnosis

Affiliations
  • 1Department of Breast and Endocrine Surgery, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
  • 2Departement of Surgery, Yonsei University College of Medicine, Seoul, Korea
  • 3Department of Surgery, Graduate School of Medicine, Yonsei University College of, Medicine, Seoul, Korea

Abstract

Background
Axillary evaluation is unnecessary for pure ductal carcinoma in situ (DCIS); however, it is performed because of the risk of upstaging to invasive cancer. We assessed the role of intraoperative frozen section (IOF) biopsy in reducing invasive cancer upstaging and axillary evaluation in preoperative DCIS patients.
Methods
We reviewed patients with preoperative DCIS who underwent breast-conserving surgery (BCS) with IOF biopsy. Positive IOF biopsy findings were defined as the presence of invasive or micro-invasive cancer. The IOF biopsy and permanent pathology findings were compared.
Results
Seventy-eight patients underwent BCS with IOF biopsy. Six patients showed positive IOF biopsy findings; five of these patients showed concordant permanent pathology findings. Sentinel lymph node biopsy (SLNB) was positive in one patient. Thirteen patients with invasive breast cancer were missed by IOF biopsy; they underwent SLNB during the second surgery. None of them had metastatic lymph nodes. The sensitivity and specificity of IOF biopsy were 27.7% and 98.3%, respectively, with 82.1% accuracy. None of the other factors showed statistically significant relationships with the permanent pathology findings, except for the IOF biopsy findings.
Conclusion
IOF evaluation can aid in detecting the invasiveness of tumors in patients with preoperative DCIS.

Keyword

Frozen Sections; Breast Neoplasms; Diagnosis

Reference

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