Role of frozen section in the intra-operative margin assessment during breast conserving surgery

Anila, KR; Chandramohan, K; Mathews, Anitha; Somanathan, Thara; Jayasree, K

doi:10.4103/0019-509x.197732

Cited by 9 publications

(17 citation statements)

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“…Study summaries are in Table 1. Thirteen papers were cohort studies [15][16][17][22][23][24][25][26][27][28][29][30][31]] and 6 were cross-sectional studies [32][33][34][35][36][37]. Those encompass a total of 6,769 frozen section assessments, including 3,811 from invasive ductal carcinoma (IDC) patients and 412 from ductal carcinoma in situ (DCIS) patients.…”

Section: Resultsmentioning

confidence: 99%

“…Eighteen were conducted at tertiary center hospitals [15,16,[22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38], and one in a no-tertiary private healthcare center [17]. Definition of negative surgical margins ranged from "no ink on tumor" in 5 studies [17,22,26,34,35], 1 mm in 5 studies [16,24,30,36,37], 2 mm in 4 studies [25,29,31,33] and 5 mm in 2 studies [15,28]. Three studies evaluated tumor on cavity shaving margins [23,27,32].…”

Section: Resultsmentioning

confidence: 99%

“…The intraoperative frozen section analysis consists of selecting suspicious margins, freezing samples submitting them to histological sections, usually with the aid of a cryostat, and staining them for microscopy analysis. However, this implies an increase of surgery time [14][15][16], as well as the possibility of margin damage [17]. Furthermore, different studies did not reach a consensus regarding its accuracy and its impact on local recurrence rates.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…For instance, according to Anila and Colleagues (2016), Intraoperative FSA allows resection of suspicious margins at the time of primary conservative surgery and results in low rates of local recurrence and second surgeries [30].…”

Section: Discussionmentioning

confidence: 99%

Concordance Between Frozen Section and Permanent Section in Assessment of Resection Margins in Breast Conserving Surgery Among Patients with Breast Cancer

Ahadi¹

2017

JCTR

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Abstract:Introduction: Breast cancer is considered as one of the most common malignancies among Iranian women and the most common cancer among women worldwide, with an incidence of over one million new cases per year worldwide, and is still the leading cause of morbidity in women with 411,000 cases per annum. The purpose of current study is to evaluate the compliance between samples of Frozen Section and Permanent section with respect to examination of the breast mass margin in breast conserving surgery. Methods and materials: Current study was retrospective cross-sectional study in which, 143 patients with BC were included via convenient sampling method. Our study's sample was obtained from patients who referred to Shohada Tajrish Hospital (Tehran, Iran) between 2009-2011 and went through breast mass surgery; subsequently, their tissue samples were assessed and reported via frozen section and permanent section methods. Obtained data was assessed via SPSS-24 software. Results: Results of Chi-square test reported the chi-square is equal to 126.392 and the degree of freedom (dof)=2, which indicates that the data is three-layered; significance=0.000 confirmed rejection of the null hypothesis and the nonuniformity of the data. Hence, It can be inferred that data are valid and testable. In the t-test, the number of data is 143 and its mean is 1.028, which is the same as the descriptive statistics. However, it differs from the mean of the society, which should be considered our Inferential-test results. Our zero assumption seeks out the same results of both methods. The results of the research are not rejected by the significance of 0.481 above 0.05, and the results can be stated to be the same on average. Conclusion: According to the obtained data, compliance of the Frozen section and the Permanent section in the examination of marginal breast masses in Shohada Tajrish Hospital; two sampling modalities show higher than 77.6% similarity. Furthermore, Frozen section modality tend to be quicker procedure and the results can be delivered to surgeon and in result he may make more accurate therapeutic decisions and this may reduce number of anesthesia and surgical procedures on a patients. Hence, due to high concordance rate between results of Frozen section and permanent section plus competitive advantage of time saving in frozen section approach, this approach may be considered as gold standard approach regarding evaluation of tumoral and non-tumoral masses in the examination of the breast mass margin in breast conserving surgery.

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“…SLN is the initial lymph node, draining the lymph from a specific area of the breast into subsequent nodes 5 . Recent advances in intra‐operative frozen section analysis (FSA) have reduced the need for a second surgery and disease recurrence 7 . Similar to FSA, touch imprint cytology (TIC) and scraping cytology (SC) are other methods used for the evaluation of SLN 11 .…”

Section: Introductionmentioning

confidence: 99%

Comparing scraping cytology with touch imprint cytology and frozen section analysis in the intraoperative diagnosis of sentinel lymph node metastasis in breast cancer

Avval

Hosseinzadeh

Farahi

et al. 2021

Diagnostic Cytopathology

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Background Breast cancer is a common cancer in the female population. Sentinel lymph node (SLN) in breast cancer patients can be evaluated by different methods including intraoperative frozen section analysis (FSA), touch imprint cytology (TIC), and scraping cytology (SC). In this study, in addition to investigating TIC and FSA, we focused on SC to evaluate the diagnostic value of this almost new method. Materials and methods In this retrospective study, the quadrantectomy and sentinel lymph node resection of 150 specimens with mammography and core needle biopsy‐confirmed breast cancer were examined. Of the 150 participants, 77 and 73 had negative and positive results for the permanent pathology of SLN metastasis, respectively. Intra‐operative FSA, TIC, and SC for SLN were performed for the patients and all were confirmed by permanent pathology. Results All the specimens were taken from females aged between 25 and 82 years. The sensitivity and specificity of TIC, FS, and SC were 73% and 50%, 92.6% and 50%, and 92.1% and 50%, respectively. Among the three techniques, TIC had the lowest positive and negative predictive values. However, FS had the highest positive predictive value whereas SC had the highest negative predictive value. Conclusion In addition to FS and TIC as rapid, cost‐effective, and reliable diagnostic methods in SLN metastasis, SC is an acceptable and highly sensitive method. A combination of these methods may provide a more favorable diagnostic value for SLN assessment in breast cancer patients.

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Role of frozen section in the intra-operative margin assessment during breast conserving surgery

Abstract: Intra-operative FSA allows resection of suspicious margins at the time of primary conservative surgery and results in low rates of local recurrence and second surgeries. There is good concordance between results of FSA and the final paraffin section in assessing margin status.

Cited by 9 publications

References 0 publications

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

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

Concordance Between Frozen Section and Permanent Section in Assessment of Resection Margins in Breast Conserving Surgery Among Patients with Breast Cancer

Comparing scraping cytology with touch imprint cytology and frozen section analysis in the intraoperative diagnosis of sentinel lymph node metastasis in breast cancer

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