Accuracy of frozen section, imprint cytology, and permanent histology of sub-nipple tissue for predicting occult nipple involvement in patients with breast carcinoma

Abstract

The sub-nipple tissue (SNT) examination has been used by surgeons to preserve, or not, the nipple in nipple-sparing mastectomy. However, it is uncertain whether SNT evaluation can predict nipple involvement. The aim of this study was to evaluate the accuracy, sensitivity, specificity, PPV, and NPV of the intraoperative frozen section and imprint cytology, and permanent histology of SNT to predict the involvement of the nipple in breast carcinoma and to compare the three exams. A prospective study was performed with 68 consecutive breast carcinoma women who had undergone mastectomy or central segmentectomy (removing nipple-areolar complex). After surgery, the nipple-areolar complex was dissected simulating a nipple-sparing flap (ex vivo). The SNT was subsequently removed and submitted to frozen section, imprint cytology, and permanent histology. The nipple was examined separately by paraffin histopathology and was considered the gold standard. The occult nipple involvement rate was 11.7 %. The frozen section, cytology, and permanent histology of SNT presented accuracy 86.8, 76.5, and 86.8 %; sensitivity 50, 37.5, and 62.5 %; specificity 91.7, 81.7, and 90 %; PPV 44.4, 21.4, and 45.5 %; and NPV 93.2, 90.7, and 94.7 %, respectively. The accuracy of the frozen section was similar to that of permanent histology (p = 0.77) and both were better than cytology (p = 0.01). False negative rates were 6.8 % for frozen section, 9.3 % for cytology and 5.3 % for paraffin. SNT evaluation is a good method for predicting occult nipple involvement; the outcomes showed a good accuracy and low false negative rate for the frozen section, cytology, and permanent histology exams. When we compared the exams, the frozen section was similar to permanent histology and more accurate than imprint cytology.

Role of breast magnetic resonance imaging in predicting malignant invasion of the nipple-areolar complex

“…The high FPR should be improved for breast MRI to be widely used in the diagnosis of NAC invasion. To prevent overtreat in MR images positive patient, it was suggested to perform subnipple biopsy [29] to confirm the malignant invasion of NAC during operation if preoperative MRI image suspect NAC invasion, whereas clinical presentation did not favor NAC invasion by cancer. In contrast to the low PPV, we found that MRI had very high NPV (reported 97.1%–97.9% in our study, and ranged from 82.0%–100% in literature review, Table 5).…”

Važnost citološke analize intraoperacijskog otiska baze mamile kod mastektomiranih pacijentica zbog karcinoma dojke

“…Prema nekim autorima, citološka je analiza intraoperacijskih otisaka baze mamile u "iskusnim rukama" pouzdanija metoda od hitne patohistoške analize, što su dokazali talijanski autori 1997. godine u svojem radu 18 , premda neki njihovi kolege imaju suprotno mišljenje [19][20][21][22] . Vuyas i sur.…”

Adenectomia mamária para o tratamento do câncer de mama inicial: importância da avaliação da margem retroareolar e da remoção dos ductos intrapapilares

“…A incidência de tumores ocultos, acometendo o mamilo, pode ocorrer em 0 a 58% dos casos com lesões maiores que 5 cm, dependendo de fatores como o tamanho tumoral e a distância do tumor em relação ao CAP. 20,21 Duarte et al 22 , em estudo prospectivo avaliando peças de mastectomia e quadrantectomia central, apontaram incidência de carcinoma oculto incidental na margem retroareolar de 11,7%, sendo cinco casos de CI e três de CDIS.…”

“…38 Karamchandani et al 39 A falta de padronização entre os cirurgiões, da técnica da AMT e da avaliação intraoperatória da margem retroareolar, pode levar à remoção do CAP sem o mesmo estar, verdadeiramente, acometido por doença. 22,45 A AIMR apresenta taxa de resultados falso-negativos de 1,5% a 16,2%.…”

“…101 Fatores como mamas volumosas, tabagismo, ptose mamária (distância do CAP ao sulco maior do que 8,0 cm), radioterapia prévia e incisão periareolar são predisponentes para aumentar a taxa de necrose do CAP, representando contraindicação relativa para essa técnica cirúrgica. 22,73 A espessura muito fina do retalho, igualmente é fator associado a chance de complicação, principalmente ao risco de necrose do CAP, sugerindo que a espessura não deva ser menor que 8,0 mm, prática que pode ser contestada oncologicamente. 81 De acordo com a análise histológica, a excisão imediata do CAP no momento da cirurgia ou tardia durante a troca do expansor, não está estatisticamente associada com o acréscimo da taxa de necrose do retalho, apesar de os números absolutos apresentarem aumento da necrose quando a excisão é imediata.…”