Abstract
BackgroundFrozen section (FS) pathology has multiple limitations, and different institutions report variable experiences with the use of FS for diagnosis of tumor involvement. We aimed to compare the FS accuracy with that of permanent pathology (gold standard) regarding marginal involvement and lymph node status using data from the largest breast cancer registry in Iran.MethodsIn this retrospective study, women who had both FS and permanent pathology reports were included. The two pathology reports were cross compared with regard to the involvement of tumor margins and sentinel lymph nodes.ResultsOverall, 2786 patients entered the study. Mean age of patients was 48.96±11.44 years. A total of 1742 margins were analyzed. Accordingly, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FS pathology for detection of involvement of involved margins were 78.49%, 97.63%, 65.1%, and 98.7%, respectively. The accuracy and area under the curve (AUC) for FS pathology were 96.61% and 0.73 (95% CI: 0.64–0.831), respectively.A total of 1702 sentinel lymph node biopsies were assessed. Sensitivity, specificity, PPV, and NPV, of FS pathology for detection of lymph node involvement, were 87.1%, 98%, 95.5%, and 93.3%, respectively. Accuracy and AUC of FS for diagnosis of involved lymph nodes were 94.1% and 0.926 (95% CI: 0.909–0.942), respectively.ConclusionFrozen pathology is a suitable method for identifying involved sentinel lymph nodes in patients with breast cancer, but this method has a less than optimum efficacy for detecting and confirming marginal involvement.
Highlights
Breast cancer (BC) remains to be an important public health issue in developed and developing countries due to its high prevalence
Considering existing limitations with Frozen section (FS) pathology and variations in institutional experiences with regard to the use of FS pathology as an assessment tool for evaluation of tumor involvement, in this study, we aimed to compare the accuracy of FS with that of permanent pathology on marginal involvement and lymph node status
The majority of tumors were grade 2 (59%) and 58.4% of the tumors had in situ components in pathology evaluation
Summary
Breast cancer (BC) remains to be an important public health issue in developed and developing countries due to its high prevalence. Breast conserving surgery (BCS) combined with postoperative radiotherapy has become the gold standard treatment for the majority of patients with early-stage BC, offering equivalent survival and improved body image and quality of life with regard to physical functioning, emotional well-being, social functioning, pain, and general health perceptions compared to patients receiving mastectomy. During BCS, surgeons may require urgent pathologic information and will request an intra-operative consultation on the excised tissue. These results will greatly influence the surgeon’s treatment decisions. Frozen section (FS) pathology has multiple limitations, and different institutions report variable experiences with the use of FS for diagnosis of tumor involvement. We aimed to compare the FS accuracy with that of permanent pathology (gold standard) regarding marginal involvement and lymph node status using data from the largest breast cancer registry in Iran
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