Sauter E R, Hoffman J P, Ottery F D, Kowalyshyn M J, Litwin S, Eisenberg B L
Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111.
Cancer. 1994 May 15;73(10):2607-12. doi: 10.1002/1097-0142(19940515)73:10<2607::aid-cncr2820731023>3.0.co;2-1.
The authors performed reexcision lumpectomy on patients with breast cancer with tumor at or close to the resection margin or if the margin status was unknown. Frozen section analysis (FSA) of reexcision lumpectomy margins was performed to allow additional excision of margins or mastectomy, saving the patient another operation or an additional radiation boost.
The authors reviewed the accuracy of FSA of margins in 107 patients undergoing reexcision lumpectomy between 1987 and 1992. There were 359 frozen sections performed on 156 specimens. Sensitivity and specificity of FSA for each frozen section margin, specimen, and patient were evaluated, as was gross inspection of tumor involvement at the resection margins. The accuracy of each pathologist's use of FSA also was evaluated.
FSA sensitivity per frozen section margin, specimen, and patient was 0.90, 0.89, and 0.85, respectively. The specificity of gross inspection was 0.97, 0.96, and 0.96 (sensitivity, 0.44), which was significantly less accurate than that of FSA (P = 0.0015) or permanent section (P = 0.019). There was no significant discordance between FSA and permanent section. Of 19 pathologists doing FSA, 6 evaluated 10 or more specimens. The error rate ranged from 4% to 10% among pathologists with 10 or more readings, whereas 12 of 13 pathologists with fewer readings had no errors. The final pathologist had a 100% error rate, significantly worse (range, P = 0.0085-0.02) than any experienced pathologist. Thirty-four (32%) patients underwent additional excision (24 patients) or mastectomy (10 patients) based on the results of FSA, which saved the patients from undergoing another operation. No one required an additional operation or a mastectomy because of a false FSA result.
FSA is safe and accurate in evaluating reexcision lumpectomy margins. Gross inspection is not reliable in margin evaluation. FSA saved an additional operation 32% of the time. Obtaining clear margins during one procedure eliminates the necessity of an additional radiation boost and probably will improve cosmesis.
对于肿瘤位于或接近切除边缘或切缘状态未知的乳腺癌患者，作者进行了再次切除肿块切除术。对再次切除肿块切除术的切缘进行冰冻切片分析（FSA），以便对切缘进行额外切除或行乳房切除术，从而为患者避免再次手术或额外的放疗增敏。
作者回顾了1987年至1992年间107例行再次切除肿块切除术患者的切缘FSA准确性。对156个标本进行了359次冰冻切片检查。评估了每个冰冻切片切缘、标本和患者的FSA敏感性和特异性，以及对切除边缘肿瘤累及情况的大体检查。还评估了每位病理学家使用FSA的准确性。
每个冰冻切片切缘、标本和患者的FSA敏感性分别为0.90、0.89和0.85。大体检查的特异性分别为0.97、0.96和0.96（敏感性为0.44），其准确性显著低于FSA（P = 0.0015）或永久切片（P = 0.019）。FSA与永久切片之间无显著不一致。在进行FSA的19位病理学家中，6位评估了10个或更多标本。在阅读量为10次或更多的病理学家中，错误率在4%至10%之间，而阅读量较少的13位病理学家中有12位没有错误。最后一位病理学家的错误率为100%，明显比任何有经验的病理学家差（范围，P = 0.0085 - 0.02）。34例（32%）患者根据FSA结果进行了额外切除（24例患者）或乳房切除术（10例患者），从而使患者避免了再次手术。没有人因为FSA结果错误而需要再次手术或乳房切除术。
FSA在评估再次切除肿块切除术切缘时安全且准确。大体检查在切缘评估中不可靠。FSA在32%的情况下避免了再次手术。在一次手术中获得清晰切缘消除了额外放疗增敏的必要性，并且可能会改善美容效果。
