Accuracy of frozen section in intraoperative margin assessment for breast-conserving surgery: A systematic review and meta-analysis

Abstract

Background and objectives It is well established that tumor-free margin is an important factor for reducing local recurrence and reoperation rates. This systematic review with meta-analysis of frozen section intraoperative margin assessment aims to evaluate the accuracy, and reoperation and survival rates, and to establish its importance in breast-conserving surgery. Methods A thorough review was conducted in all online publication-databases for the related literature up to March 2020. MeSH terms used: “Breast Cancer”, “Segmental Mastectomy” and “Frozen Section”. We included the studies that evaluated accuracy of frozen section, reoperation and survival rates. To ensure quality of the included articles, the QUADAS-2 tool (adapted) was employed. The assessment of publication bias by graphical and statistical methods was performed using the funnel plot and the Egger’s test. The review protocol was registered in PROSPERO (CRD42019125682). Results Nineteen studies were deemed suitable, with a total of 6,769 cases. The reoperation rate on average was 5.9%. Sensitivity was 0.81, with a Confidence Interval of 0.79–0.83, p = 0.0000, I2 = 95.1%, and specificity was 0.97, with a Confidence Interval of 0.97–0.98, p = 0.0000, I-2 = 90.8%, for 17 studies and 5,615 cases. Accuracy was 0.98. Twelve studies described local recurrence and the highest cumulative recurrence rate in 3 years was 7.5%. The quality of the included studies based on the QUADAS-2 tool showed a low risk of bias. There is no publication bias (p = 0.32) and the funnel plot showed symmetry. Conclusion Frozen section is a reliable procedure with high accuracy, sensitivity and specificity in intraoperative margin assessment of breast-conserving surgery. Therefore, this modality of margin assessment could be useful in reducing reoperation rates.

A Randomized Controlled Trial for Doing vs. Omitting Intraoperative Frozen Section Biopsy for Resection Margin Status in Selected Patients Undergoing Breast-Conserving Surgery (OFF-MAP Trial)

“…Although the superiority of frozen section biopsy for evaluating resection margins and obtaining negative margins has not been demonstrated in a prospective trial, the high accuracy and reliability of frozen section biopsy have been determined in meta-analyses [ 8 26 ]. A recent meta-analysis reported an average reoperation rate of 5.9% when frozen section biopsy was performed, which is considerably lower than the reoperation rates previously reported by nationwide and registry-based studies (11.6%–14.0%) [ 4 9 27 ].…”

Progress on deep learning in digital pathology of breast cancer: a narrative review

“…Breast-conserving surgery (BCS) followed by radiation therapy (RT) is the standard procedure of early-stage breast cancer treatment. If clear margins are obtained, it could provide similar survival rates as total mastectomy while better cosmetic results (114,115).…”

Development and Validation of a Prediction Model for Positive Margins in Breast-Conserving Surgery

“…The extent of its use depends on the preferences of the treating center. According to evidence, the frozen section technique is highly accurate for evaluating the intraoperative margin of BCS ( 9 ) and reducing reoperation rates ( 3 , 10 ). However, its complexity, time-consuming nature, and heavy workload limit its universal acceptance ( 7 , 10 ).…”