Accuracy and interobserver agreement of retroareolar frozen sections in nipple-sparing mastectomies |
| |
| Affiliation: | 1. Department of Pathology and Laboratories, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia;2. Division of Breast Surgery, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia;3. Division of Plastic and Reconstructive Surgery, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia;4. School of Medicine, Universidad de los Andes, Bogotá D.C., Colombia;1. Department of Medical Sciences, University of Turin, Turin 10126, Italy;2. Department of Pathology, Clinical Center, University of Sarajevo, Sarajevo 71000, Bosnia and Herzegovina;3. Caris Life Sciences, Phoenix, AZ 85040, USA;4. Medical Genetics Center, Department of Cell Biology and Genetics, Center of Biomedical Genetics, Erasmus MC, Rotterdam 3015, the Netherlands;5. Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá 110010, Colombia;6. Center for Experimental Research and Medical Studies, San Giovanni Battista Hospital, Turin 10100, Italy;1. Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud, Pública, Avenida Universidad, No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico;2. Departamento de Evaluación Clínica de Intervenciones para la Salud, Dirección de Evaluación de Tecnologías para la Salud, Centro Nacional de Excelencia Tecnológica en Salud, Paseo de la Reforma No. 450, Piso 13, Col. Juárez, Del. Cuauhtémoc, Distrito Federal 06600, Mexico;3. Departamento de Salud Pública, Universidad del Norte, Km. 5 Vía Puerto Colombia, Barranquilla, Colombia |
| |
| Abstract: | In the last decades, surgical treatment of breast cancer has enormously changed. As a result, nipple-sparing mastectomy (NSM) has evolved as an oncologically safe and cosmetic approach. NSM includes a subareolar frozen section to evaluate malignancy. We determined the accuracy of subareolar frozen section diagnosis, analyzed the discrepancy factor, and estimated the interobserver agreement of frozen section in NSM. A retrospective review of all NSMs at our institution from 2009 to 2015 was performed. Frozen sections were compared to the final diagnoses to analyze the accuracy of subareolar frozen sections. Discordant results were rigorously evaluated to identify discrepancy factors. Some cases were randomly chosen to assess the interobserver agreement (kappa) among pathologists. The agreement results were evaluated with and without knowledge of the tumor morphology. Among 34 NSMs, the frozen section false-negative and false-positive rate was 5.9% and 8.8%, respectively. The sensitivity and specificity was 77.8% and 88.0%, respectively. Sampling errors and diathermy artifacts explained our false-negative diagnoses. Freezing artifacts and an intraductal papilloma explained our false-positive diagnoses. The interobserver agreement between breast and general pathologists was 0.87 (p < 0.0001) and 0.31 (p = 0.0001), respectively. The interobserver agreement increased to 0.35 (p < 0.0001) in general pathologists with knowledge of the tumor morphology. Subareolar frozen section showed to be a specific test with moderate sensitivity. Papillary lesions can mimic atypical cells and influence the frozen section interpretation. Frozen section in NSM had a better performance in breast pathologists (almost perfect) versus general pathologists (fair). Interobserver agreement may improve with knowledge of tumor morphology. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
