Jorns Julie M, Daignault Stephanie, Sabel Michael S, Wu Angela J
From the Department of Pathology,
Center for Cancer Biostatistics, School of Public Health, and.
Am J Clin Pathol. 2014 Nov;142(5):601-8. doi: 10.1309/AJCPRSOA2G8RLEXY.
A prior study at our institution showed a marked reduction in reoperation for margin reexcision following the development of an intraoperative frozen section evaluation of margins (FSM) practice on lumpectomy specimens from patients undergoing breast-conserving therapy (BCT). This study aimed to examine the frequency of FSM utilization, FSM pathology performance, and outcomes for BCT patients undergoing margin reexcision only.
Consecutive reexcision-only specimens were reviewed from a 40-month period following the development of the FSM practice. Clinicopathologic features and patient outcomes were assessed.
FSM was performed in 46 (30.7%) of 150 reexcision-only operations. Of the 46 operations with FSM, there were 28 (60.9%) true-negative, 12 (26.1%) true-positive, six (13.0%) false-negative, and no false-positive cases. There was no difference in further reexcision, total operations, or conversion to mastectomy among patients with and without FSM. Need for further reexcision was significantly associated with tumor multifocality (P = .008).
Despite overall good pathology performance for FSM in reexcision-only specimens, use of FSM did not affect patient outcome. Rather, underlying disease biology appeared most significant in predicting whether adequate surgical margins could be attained.
我们机构之前的一项研究表明，在对接受保乳治疗（BCT）的患者的乳房肿块切除标本进行术中切缘冷冻切片评估（FSM）后，切缘再次切除的再次手术率显著降低。本研究旨在检查仅接受切缘再次切除的BCT患者的FSM使用频率、FSM病理表现及结果。
对开展FSM实践后的40个月期间连续的仅再次切除标本进行回顾。评估临床病理特征和患者结果。
150例仅再次切除手术中有46例（30.7%）进行了FSM。在46例进行FSM的手术中，有28例（60.9%）为真阴性，12例（26.1%）为真阳性，6例（13.0%）为假阴性，无假阳性病例。有FSM和无FSM的患者在进一步再次切除、总手术次数或转为乳房切除术方面无差异。进一步再次切除的需求与肿瘤多灶性显著相关（P = .008）。
尽管FSM在仅再次切除标本中的病理表现总体良好，但FSM的使用并未影响患者结局。相反，基础疾病生物学在预测能否获得足够的手术切缘方面似乎最为重要。
