术前诊断为导管内癌时保乳手术腋窝处理中冰冻切片在决策中的作用。

Frozen Sections in Decision-Making Regarding the Axillary Procedures in Breast Conserving Surgery for Intraductal Carcinoma at Preoperative Diagnosis.

机构信息

Department of Breast and Endocrine Surgery, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

Departement of Surgery, Yonsei University College of Medicine, Seoul, Korea.

出版信息

J Korean Med Sci. 2023 Jul 31;38(30):e224. doi: 10.3346/jkms.2023.38.e224.

DOI:10.3346/jkms.2023.38.e224

PMID:37527907

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10396433/

Abstract

BACKGROUND

Axillary evaluation is unnecessary for pure ductal carcinoma in situ (DCIS); however, it is performed because of the risk of upstaging to invasive cancer. We assessed the role of intraoperative frozen section (IOF) biopsy in reducing invasive cancer upstaging and axillary evaluation in preoperative DCIS patients.

METHODS

We reviewed patients with preoperative DCIS who underwent breast-conserving surgery (BCS) with IOF biopsy. Positive IOF biopsy findings were defined as the presence of invasive or micro-invasive cancer. The IOF biopsy and permanent pathology findings were compared.

RESULTS

Seventy-eight patients underwent BCS with IOF biopsy. Six patients showed positive IOF biopsy findings; five of these patients showed concordant permanent pathology findings. Sentinel lymph node biopsy (SLNB) was positive in one patient. Thirteen patients with invasive breast cancer were missed by IOF biopsy; they underwent SLNB during the second surgery. None of them had metastatic lymph nodes. The sensitivity and specificity of IOF biopsy were 27.7% and 98.3%, respectively, with 82.1% accuracy. None of the other factors showed statistically significant relationships with the permanent pathology findings, except for the IOF biopsy findings.

CONCLUSION

IOF evaluation can aid in detecting the invasiveness of tumors in patients with preoperative DCIS.

摘要

背景

单纯导管原位癌（DCIS）不需要腋窝评估；但是，由于存在升级为浸润性癌的风险，所以还是进行了评估。我们评估了术中冰冻切片（IOF）活检在降低术前 DCIS 患者浸润性癌升级和腋窝评估中的作用。

方法

我们回顾了接受保乳手术（BCS）并进行 IOF 活检的术前 DCIS 患者。IOF 活检阳性结果定义为存在浸润性或微浸润性癌。比较了 IOF 活检和永久病理检查结果。

结果

78 例患者接受了 BCS 加 IOF 活检。6 例患者的 IOF 活检结果为阳性；其中 5 例患者的永久病理检查结果一致。1 例患者的前哨淋巴结活检（SLNB）阳性。13 例浸润性乳腺癌患者被 IOF 活检漏诊；他们在第二次手术中接受了 SLNB。他们均无转移性淋巴结。IOF 活检的敏感性和特异性分别为 27.7%和 98.3%，准确率为 82.1%。除 IOF 活检结果外，其他因素与永久病理检查结果均无统计学意义上的关系。