Department of Surgical Oncology, Tohoku University School of Medicine, Sendai 980-8574, Japan.
Jpn J Clin Oncol. 2010 Jun;40(6):513-20. doi: 10.1093/jjco/hyq006. Epub 2010 Feb 26.
One problem existing in breast-conservation surgery is ipsilateral breast tumour recurrence, and one of its major risk factors is surgical margin positivity. We therefore investigated whether total-circumference surgical margin examination can reduce surgical margin-positive rates.
A total of 122 cases were examined after BCS was performed between March 2004 and March 2006. After partial mastectomy, specimens were taken from the remnant breast side along the total-circumference of the mammary gland (width, approximately 5 mm). Intraoperative frozen section analysis was performed for those specimens. Margin-positive cases were defined as those showing malignancy within <or=5 mm of the final margin as revealed by final diagnosis.
If intraoperative frozen section analysis had not been performed, 33 cases (27%) would have been diagnosed as margin-positive. However, it reduced the number of margin-positive cases to 12 (9.8%), and final margin-positivity rates were thus significantly reduced (P < 0.001). As for the accuracy of intraoperative frozen section analysis, sensitivity was 78.6%, specificity was 100%, correct diagnosis rate was 95.1%, positive predictive value was 100% and negative predictive value was 94.0%. False-negatives were caused by the detection of malignancy as revealed in permanent specimens. Margin-positive sites were not limited to the nipple and distal (peripheral) sites, with equivalent margin-positive cases found laterally.
Total-circumference surgical margin examination by IFSA for BCS significantly reduced margin-positive rates from 27% to 9.8%.
保乳手术存在的一个问题是同侧乳房肿瘤复发，其主要危险因素之一是手术切缘阳性。因此，我们研究了全周长切缘检查是否能降低切缘阳性率。
2004 年 3 月至 2006 年 3 月行保乳手术后，对 122 例患者进行检查。在部分乳房切除术后，从残留乳房侧沿乳腺全周长（宽度约 5mm）取标本。对这些标本进行术中冰冻切片分析。切缘阳性定义为最终诊断显示切缘＜5mm 有恶性肿瘤。
如果不进行术中冰冻切片分析，将有 33 例（27%）被诊断为切缘阳性。但将切缘阳性病例数减少至 12 例（9.8%），最终切缘阳性率显著降低（P＜0.001）。术中冰冻切片分析的准确性方面，其敏感性为 78.6%，特异性为 100%，正确诊断率为 95.1%，阳性预测值为 100%，阴性预测值为 94.0%。假阴性是由于在永久标本中发现了恶性肿瘤。切缘阳性部位不仅限于乳头和远端（外周）部位，也有相当于侧面的切缘阳性病例。
BCS 的 IFSA 全周长切缘检查显著降低了切缘阳性率，从 27%降至 9.8%。
