Luo Daniel, Ha Jennifer, Latham Bruce, Ingram David, Connell Tony, Hastrich Diana, Yeow Weng-Chan, Willsher Peter, Luo Joseph
Ochsner J. 2010 Fall;10(3):188-92.
Intraoperative subareolar frozen sections are used to assess the nipple areolar complex's suitability for preservation for patients selected for nipple-sparing mastectomy. We aim to investigate the accuracy and value of the frozen section compared to formal histopathologic results.
In our 5-year retrospective study, 52 candidates for nipple-sparing mastectomies had subareolar frozen sections analyzed intraoperatively for malignant or atypical duct changes. Women were considered for nipple-sparing mastectomy if their primary breast malignancy was greater than 3 cm from the nipple-areolar complex and not multifocal in nature. Frozen-section results were compared to the formal histopathologic results, allowing analysis of the sensitivity, specificity, and predictive value. Causes of false negatives (negative frozen-section findings, positive histopathology findings) were then examined.
Of 52 frozen sections, 47 (90%) yielded negative results and 5 (10%) yielded positive results. Of the 47 negative results, 39 were true negatives while 8 were false negatives. Of the 5 positive results, all were true positives with no false positives. Therefore, the positive predictive value of subareolar frozen section is 100%, negative predictive value 83%, sensitivity 38%, and specificity 100%. Of the 8 false negatives, 4 (50%) were due to sampling errors, 3 (37.5%) were due to interpretation errors, and 1 (12.5%) was due to diathermy artifact.
Intraoperative subareolar frozen section is a specific but nonsensitive test. It is useful in nipple-sparing mastectomy because in 10% of cases a positive result allows immediate nipple and areolar excision. Its low sensitivity and negative predictive value means that 15% of patients will need a subsequent nipple and areolar excision. Eighty-five percent of patients can, however, have a single-stage excision.
术中乳晕下冰冻切片用于评估保乳手术患者乳头乳晕复合体保留的适宜性。我们旨在研究冰冻切片结果与常规组织病理学结果相比的准确性和价值。
在我们为期5年的回顾性研究中，52例保乳手术候选患者术中对乳晕下冰冻切片进行分析，以检测是否存在恶性或非典型导管改变。如果原发性乳腺恶性肿瘤距离乳头乳晕复合体大于3 cm且非多灶性，则考虑行保乳手术。将冰冻切片结果与常规组织病理学结果进行比较，分析其敏感性、特异性和预测价值。然后检查假阴性（冰冻切片结果为阴性，组织病理学结果为阳性）的原因。
52例冰冻切片中，47例（90%）结果为阴性，5例（10%）结果为阳性。在47例阴性结果中，39例为真阴性，8例为假阴性。在5例阳性结果中，全部为真阳性，无假阳性。因此，乳晕下冰冻切片的阳性预测值为100%，阴性预测值为83%，敏感性为38%，特异性为100%。在8例假阴性中，4例（50%）是由于取样误差，3例（37.5%）是由于解读误差，1例（12.5%）是由于透热损伤。
术中乳晕下冰冻切片是一项特异性高但敏感性低的检查。它在保乳手术中有用，因为在10%的病例中，阳性结果可立即切除乳头和乳晕。其低敏感性和阴性预测值意味着15%的患者需要随后切除乳头和乳晕。然而，85%的患者可以进行一期切除。
