Suarez-Zamora David A, Barrera-Herrera Luis E, Palau-Lazaro Mauricio A, Torres-Franco Fabio, Orozco-Plazas Alejandro, Barreto-Hauzeur Lisette, Rodriguez-Urrego Paula A
Department of Pathology and Laboratories, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia.
Department of Pathology and Laboratories, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia; School of Medicine, Universidad de los Andes, Bogotá D.C., Colombia.
Ann Diagn Pathol. 2017 Aug;29:46-51. doi: 10.1016/j.anndiagpath.2017.05.001. Epub 2017 May 3.
In the last decades, surgical treatment of breast cancer has enormously changed. As a result, nipple-sparing mastectomy (NSM) has evolved as an oncologically safe and cosmetic approach. NSM includes a subareolar frozen section to evaluate malignancy. We determined the accuracy of subareolar frozen section diagnosis, analyzed the discrepancy factor, and estimated the interobserver agreement of frozen section in NSM. A retrospective review of all NSMs at our institution from 2009 to 2015 was performed. Frozen sections were compared to the final diagnoses to analyze the accuracy of subareolar frozen sections. Discordant results were rigorously evaluated to identify discrepancy factors. Some cases were randomly chosen to assess the interobserver agreement (kappa) among pathologists. The agreement results were evaluated with and without knowledge of the tumor morphology. Among 34 NSMs, the frozen section false-negative and false-positive rate was 5.9% and 8.8%, respectively. The sensitivity and specificity was 77.8% and 88.0%, respectively. Sampling errors and diathermy artifacts explained our false-negative diagnoses. Freezing artifacts and an intraductal papilloma explained our false-positive diagnoses. The interobserver agreement between breast and general pathologists was 0.87 (p<0.0001) and 0.31 (p=0.0001), respectively. The interobserver agreement increased to 0.35 (p<0.0001) in general pathologists with knowledge of the tumor morphology. Subareolar frozen section showed to be a specific test with moderate sensitivity. Papillary lesions can mimic atypical cells and influence the frozen section interpretation. Frozen section in NSM had a better performance in breast pathologists (almost perfect) versus general pathologists (fair). Interobserver agreement may improve with knowledge of tumor morphology.
在过去几十年中，乳腺癌的外科治疗发生了巨大变化。因此，保乳手术（NSM）已发展成为一种肿瘤学上安全且具有美容效果的方法。NSM包括乳晕下冰冻切片以评估恶性肿瘤。我们确定了乳晕下冰冻切片诊断的准确性，分析了差异因素，并估计了NSM中冰冻切片的观察者间一致性。对我们机构2009年至2015年所有的NSM进行了回顾性研究。将冰冻切片与最终诊断结果进行比较，以分析乳晕下冰冻切片的准确性。对不一致的结果进行严格评估以确定差异因素。随机选择一些病例来评估病理学家之间的观察者间一致性（kappa值）。在知晓和不知晓肿瘤形态的情况下对一致性结果进行评估。在34例NSM中，冰冻切片假阴性率和假阳性率分别为5.9%和8.8%。敏感性和特异性分别为77.8%和88.0%。抽样误差和透热伪像解释了我们的假阴性诊断。冰冻伪像和导管内乳头状瘤解释了我们的假阳性诊断。乳腺病理学家和普通病理学家之间的观察者间一致性分别为0.87（p<0.0001）和0.31（p = 0.0001）。在知晓肿瘤形态的普通病理学家中，观察者间一致性提高到0.35（p<0.0001）。乳晕下冰冻切片显示是一种具有中等敏感性的特异性检查。乳头状病变可模仿非典型细胞并影响冰冻切片的解读。NSM中的冰冻切片在乳腺病理学家（几乎完美）与普通病理学家（一般）之间表现更好。知晓肿瘤形态可能会提高观察者间一致性。
