How accurate is frozen section pathology compared to permanent pathology in detecting involved margins and lymph nodes in breast cancer?

Abstract

Background Frozen section (FS) pathology has multiple limitations, and different institutions report variable experiences with the use of FS for diagnosis of tumor involvement. We aimed to compare the FS accuracy with that of permanent pathology (gold standard) regarding marginal involvement and lymph node status using data from the largest breast cancer registry in Iran. Methods In this retrospective study, women who had both FS and permanent pathology reports were included. The two pathology reports were cross compared with regard to the involvement of tumor margins and sentinel lymph nodes. Results Overall, 2786 patients entered the study. Mean age of patients was 48.96±11.44 years. A total of 1742 margins were analyzed. Accordingly, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FS pathology for detection of involvement of involved margins were 78.49%, 97.63%, 65.1%, and 98.7%, respectively. The accuracy and area under the curve (AUC) for FS pathology were 96.61% and 0.73 (95% CI: 0.64–0.831), respectively. A total of 1702 sentinel lymph node biopsies were assessed. Sensitivity, specificity, PPV, and NPV, of FS pathology for detection of lymph node involvement, were 87.1%, 98%, 95.5%, and 93.3%, respectively. Accuracy and AUC of FS for diagnosis of involved lymph nodes were 94.1% and 0.926 (95% CI: 0.909–0.942), respectively. Conclusion Frozen pathology is a suitable method for identifying involved sentinel lymph nodes in patients with breast cancer, but this method has a less than optimum efficacy for detecting and confirming marginal involvement.

Cost‐Efficacy Analysis of Use of Frozen Section Histology for Margin Assessment During Breast Conservation Surgery in Breast Cancer Patients

“…A study done by Nunez A et al reported a lower FNR of 8.6% and a higher FPR of 11.6%, accuracy of 80%, sensitivity 49%, specificity 86%, PPV 42%, and NPV 89% [20]. In another study done by Namdar et al, the overall accuracy of IFSH was 96.61% [21]. The study conducted by Boughey et al at Mayo clinic supports the adoption of IFSH assessment by all institutions to offer cost savings [7, 22].…”

Application of near-infrared fluorescence imaging in the accurate assessment of surgical margins during breast-conserving surgery

“…Inaccurate results from frozen sections will affect the operation performed by surgeons, and false negatives from frozen margins will also be encountered in the clinic. For example, intraoperative freezing indicates that the margin is negative, whereas postoperative pathology suggests the presence of residual tumor in the margin [ 23 , 24 ]. The high sensitivity of spectral-level imaging enables the detection of potentially malignant lesions in a new and feasible manner.…”

Mass Spectrometry Imaging of Lumpectomy Specimens Deciphers Diacylglycerols as Potent Biomarkers for the Diagnosis of Breast Cancer

“…2 Therefore, postoperative assessment of the histopathological sections (permanent sections), a nearly accurate biopsy method that typically takes a few days, is a routine practice in distinguishing BC from adjacent normal tissue. 3 If the margin is found positive, another round of surgery is often recommended, delaying the subsequent therapy and increasing the risk of cancer recurrence or infection in the surgical site. Therefore, this setback invites innovative tools for rapid and accurate discrimination between cancer and adjacent normal breast tissues, compatible with the intraoperative workflow.…”

“…However, none of these techniques are widely adopted for limited accuracy (up to 40% error rate), slow turnaround time, and subjective interpretation . Therefore, postoperative assessment of the histopathological sections (permanent sections), a nearly accurate biopsy method that typically takes a few days, is a routine practice in distinguishing BC from adjacent normal tissue . If the margin is found positive, another round of surgery is often recommended, delaying the subsequent therapy and increasing the risk of cancer recurrence or infection in the surgical site.…”