Ko SeungSang, Chun Yi Kyeong, Kang Sung Soo, Hur Min Hee
Department of Surgery, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.
Department of Pathology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.
J Breast Cancer. 2017 Jun;20(2):176-182. doi: 10.4048/jbc.2017.20.2.176. Epub 2017 Jun 26.
Intraoperative frozen-section analysis of the lumpect-omy margin during breast-conserving surgery (BCS) is an excellent method in obtaining a clear resection margin. This study aimed to investigate the usefulness of intraoperative circumferential frozen-section analysis (IOCFS) of lumpectomy margin during BCS for breast cancer, and to find factors that increase the conversion into mastectomy.
From 2007 to 2011, 509 patients with breast cancer underwent IOCFS during BCS. The outer surfaces of the shaved lumpectomy margins were evaluated. A negative margin was defined as no ink on the tumor. All margins were evaluated using the permanent section analysis.
Among the 509 patients, 437 (85.9%) underwent BCS and 72 (14.1%) finally underwent mastectomy. Of the 483 pathologically confirmed patients, 338 (70.0%) were true-negative, 24 (5.0%) false-negative, 120 (24.8%) true-positive, and 1 (0.2%) false-positive. Twenty-four patients (4.7%) among total 509 patients had undetermined margins as either atypical ductal hyperplasia or ductal carcinoma in the first IOCFS. The IOCFS has an accuracy of 94.8% with 83% sensitivity, 99.7% specificity, 93.4% negative predictive value, and 99.2% positive predictive value. Sixty-three cases (12.4%) were converted to mastectomy, the first intraoperatively. Of the 446 (87.6%) patients who successfully underwent BCS, 64 patients received additional excisions and 32 were reoperated to achieve clear margin (reoperation rate, 6.3%). Twenty-three of the reoperated patients underwent re-excisions using the second intraoperative frozen section analysis, and achieved BCS. Nine cases were additionally converted to mastectomy. No significant differences in age, stage, and biological factors were found between the BCS and mastectomy cases. Factors such as invasive lobular carcinoma, multiple tumors, large tumor, and multiple excisions increased the conversion to mastectomy.
The IOCFS analysis during BCS is useful in evaluating lumpectomy margins and preventing reoperation.
保乳手术（BCS）中对肿块切除边缘进行术中冰冻切片分析是获得切缘阴性的一种极佳方法。本研究旨在探讨BCS治疗乳腺癌时对肿块切除边缘进行术中圆周冰冻切片分析（IOCFS）的实用性，并找出增加转为乳房切除术的因素。
2007年至2011年期间，509例乳腺癌患者在BCS过程中接受了IOCFS。对切除肿块边缘的外表面进行评估。切缘阴性定义为肿瘤上无墨水标记。所有边缘均采用永久切片分析进行评估。
509例患者中，437例（85.9%）接受了BCS，72例（14.1%）最终接受了乳房切除术。在483例病理确诊的患者中，338例（70.0%）为真阴性，24例（5.0%）为假阴性，120例（24.8%）为真阳性，1例（0.2%）为假阳性。在509例患者中，有24例（4.7%）在首次IOCFS时边缘不确定，为非典型导管增生或导管原位癌。IOCFS的准确率为94.8%，敏感性为83%，特异性为99.7%，阴性预测值为93.4%，阳性预测值为99.2%。63例（12.4%）术中首次转为乳房切除术。在成功接受BCS的446例（87.6%）患者中，64例接受了额外切除，32例再次手术以获得切缘阴性（再次手术率为6.3%）。23例再次手术的患者使用第二次术中冰冻切片分析进行了再次切除，并成功接受了BCS。9例额外转为乳房切除术。BCS组和乳房切除术组在年龄、分期和生物学因素方面未发现显著差异。诸如浸润性小叶癌、多灶性肿瘤、大肿瘤和多次切除等因素增加了转为乳房切除术的几率。
BCS过程中的IOCFS分析有助于评估肿块切除边缘并预防再次手术。
