Diagnostic accuracy and challenges of intraoperative frozen section evaluation for axillary sentinel lymph node biopsy and breast margins

IF 3.9 2区医学 Q2 CELL BIOLOGY

Histopathology Pub Date : 2025-02-11 DOI:10.1111/his.15418

Natthawadee Laokulrath, Nur Diyana Md Nasir, Mihir Gudi, Puay Hoon Tan

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引用次数: 0

Abstract

Aims

Our study aims to audit and evaluate the accuracy and pitfalls of intraoperative evaluation of frozen sentinel lymph nodes (IOE-FSLN) and resection margins (IOE-FSM) compared to final findings in paraffin sections.

Methods

A total of 264 cases underwent intraoperative evaluation, encompassing 688 sentinel lymph nodes (SLNs) and 1186 surgical margins. Frozen section (FS) diagnoses were compared with corresponding permanent sections of FS (PFS). Sensitivity, specificity, false-negative rate, false-positive rate, and concordance rates were assessed. Cases with discrepancies underwent a detailed histological review.

Results

The study predominantly comprised cases of invasive breast carcinoma (IBC) (74%). For FSLN reporting, sensitivity was 88.1%, specificity 100%, and FS-PFS concordance 99.0%. FSM reporting showed sensitivity of 85.0%, specificity 99.9%, and concordance 98.4%. Sampling errors accounted for 86% (FSLN) and 88% (FSM) of discrepancies, with interpretive errors present in 1/7 FSLN and in 2/17 FSM cases. The shave margin method demonstrated a higher false-negative rate in FSM reporting. The rate of final positive margins was reduced from 21.3% to 11.4% when IOE-FSM was utilized.

Conclusion

IOE-FSLN and IOE-FSM showed high reliability in guiding intraoperative decisions for axillary lymph node dissection and achieving free surgical margins in one-stage surgeries. However, limitations include challenges in distinguishing metastatic carcinoma from benign mimics in FSLN and diagnosing certain features such as IBC with post-treatment changes, invasive lobular carcinoma in FSLN and FSM; IBC rich in tumour-infiltrating lymphocytes, low-grade (DCIS/IBC in FSM) without immunohistochemical studies.

Abstract Image

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术中冰冻切片评估腋窝前哨淋巴结活检和乳腺边缘的诊断准确性和挑战。

目的：我们的研究旨在审核和评估术中冷冻前哨淋巴结（IOE-FSLN）和切除边缘（IOE-FSM）评估的准确性和缺陷，并将其与石蜡切片的最终结果进行比较。方法：264例患者行术中评估，包括688个前哨淋巴结（sln）和1186个手术缘。将冷冻切片（FS）的诊断结果与相应的永久切片（PFS）进行比较。评估敏感性、特异性、假阴性率、假阳性率和一致性率。有差异的病例进行了详细的组织学检查。结果：本研究以浸润性乳腺癌（IBC）为主（74%）。FSLN报告的敏感性为88.1%，特异性为100%，FS-PFS一致性为99.0%。FSM报告敏感性85.0%，特异性99.9%，一致性98.4%。抽样误差占差异的86% （FSLN）和88% (FSM)，在1/7的FSLN和2/17的FSM案例中存在解释误差。刮刀边际法在FSM报告中显示出较高的假阴性率。当使用IOE-FSM时，最终阳性边缘率从21.3%降至11.4%。结论：IOE-FSLN和IOE-FSM在一期手术中指导腋淋巴结清扫术中决策及获得游离切缘具有较高的可靠性。然而，局限性包括在FSLN中区分转移癌和良性模拟癌的挑战，以及诊断某些特征，如治疗后改变的IBC， FSLN和FSM的浸润性小叶癌；IBC富含肿瘤浸润淋巴细胞，低级别（DCIS/IBC在FSM），没有免疫组织化学研究。

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来源期刊

Histopathology 医学-病理学

CiteScore

10.20

自引率

4.70%

发文量

239

审稿时长

1 months

期刊介绍： Histopathology is an international journal intended to be of practical value to surgical and diagnostic histopathologists, and to investigators of human disease who employ histopathological methods. Our primary purpose is to publish advances in pathology, in particular those applicable to clinical practice and contributing to the better understanding of human disease.