Frozen Sections in Decision-Making Regarding the Axillary Procedures in Breast Conserving Surgery for Intraductal Carcinoma at Preoperative Diagnosis

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Authors: Sanghwa Kim ; Kwanbum Lee ; Mushabab Ali Alshahrani ; Jee Hyun Ahn ; Jeea Lee ; Hyung Seok Park

MeSH: Breast Neoplasms* / diagnosis ; Breast Neoplasms* / pathology ; Breast Neoplasms* / surgery ; Carcinoma, Intraductal, Noninfiltrating* / diagnosis ; Carcinoma, Intraductal, Noninfiltrating* / pathology ; Carcinoma, Intraductal, Noninfiltrating* / surgery ; Female ; Frozen Sections ; Humans ; Lymph Nodes / pathology ; Mastectomy, Segmental ; Sentinel Lymph Node Biopsy

Abstract: Background: Axillary evaluation is unnecessary for pure ductal carcinoma in situ (DCIS); however, it is performed because of the risk of upstaging to invasive cancer. We assessed the role of intraoperative frozen section (IOF) biopsy in reducing invasive cancer upstaging and axillary evaluation in preoperative DCIS patients.

Methods: We reviewed patients with preoperative DCIS who underwent breast-conserving surgery (BCS) with IOF biopsy. Positive IOF biopsy findings were defined as the presence of invasive or micro-invasive cancer. The IOF biopsy and permanent pathology findings were compared.

Results: Seventy-eight patients underwent BCS with IOF biopsy. Six patients showed positive IOF biopsy findings; five of these patients showed concordant permanent pathology findings. Sentinel lymph node biopsy (SLNB) was positive in one patient. Thirteen patients with invasive breast cancer were missed by IOF biopsy; they underwent SLNB during the second surgery. None of them had metastatic lymph nodes. The sensitivity and specificity of IOF biopsy were 27.7% and 98.3%, respectively, with 82.1% accuracy. None of the other factors showed statistically significant relationships with the permanent pathology findings, except for the IOF biopsy findings.

Conclusion: IOF evaluation can aid in detecting the invasiveness of tumors in patients with preoperative DCIS.