The Usefulness of Intraoperative Circumferential Frozen-Section Analysis of Lumpectomy Margins in Breast-Conserving Surgery.
The Usefulness of Intraoperative Circumferential Frozen-Section Analysis of Lumpectomy Margins in Breast-Conserving Surgery.
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DOI：
10.4048/jbc.2017.20.2.176
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发表时间：
2017-06
影响因子：
2.4
通讯作者：
Hur MH
中科院分区：
文献类型：
--
作者：
Ko S;Chun YK;Kang SS;Hur MH
在保乳手术（BCS）中对肿块切除边缘进行术中冰冻切片分析是获得清晰切除边缘的一种很好的方法。本研究旨在探讨乳腺癌BCS术中肿块切除术边缘的术中环形冰冻切片分析（IOCFS）的有效性，并寻找增加乳腺切除术转换的因素。从2007年到2011年，509例乳腺癌患者在BCS期间接受了IOCFS。对剃毛的乳房肿瘤切除术边缘的外表面进行评价。阴性边缘定义为肿瘤上没有墨水。使用永久切片分析评价所有边缘。在509例患者中，437例（85.9%）接受BCS，72例（14.1%）最终接受乳房切除术。在483例病理证实的患者中，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。509例患者中有24例（4.7%）在第一次IOCFS中边缘不确定，为不典型导管增生或导管原位癌。IOCFS的准确性为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%）转为乳房切除术，为首次术中手术。在446例（87.6%）成功接受BCS的患者中，64例患者接受了额外切除，32例再次手术以获得清晰的边缘（再次手术率，6.3%）。23例再次手术患者使用第二次术中冷冻切片分析进行了再次切除，并实现了BCS。另外9例转为乳房切除术。BCS和乳房切除术病例在年龄、分期和生物学因素方面无显著差异。浸润性小叶癌、多发性肿瘤、大肿瘤和多次切除等因素增加了乳腺切除术的转化率。BCS期间的IOCFS分析有助于评估肿块切除边缘和预防再次手术。
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 situ 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.