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| Clinical study of intraoperative frozen pathological section in evaluating the margin of breast conserving surgery |
| FANG Chen XIE Feng-feng XIE Wan-jun ZHANG Qing-ling |
| Department of Galactophore, Guangdong Hospital of Traditional Chinese Medicine, Guangzhou 510120, China |
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Abstract Objective To explore the clinical role of frozen pathological section in the evaluation of breast cancer during breast conserving surgery.Methods The clinical data of 751 cases of patients who underwent the breast conserving surgery and used the frozen pathological section as intraoperative margin assessment from December 2011 to July 2017 were retrospectively analyzed.The incidence of positive margins, secondary surgery rate and relevant factors of positive margins were analyzed.The difference between the positive margin group and the negative margin group as well as the second surgery and non-secondary surgery in terms of operation time, operation cost and pathological examination cost,the total incidence rate of postoperative complications in the positive margin group and the negative margin group , and coincidence rate of frozen pathology and paraffin pathology were compared.Results Of the 751 cases, 565 (75.2%)were in the negative margin group, and 186 (24.8%) were in the positive margin group, of which 31 (4.1%) experienced secondary surgery, and in non-secondary surgery, 155 cases (20.6%) of the frozen pathological section showed positive in the first marginal state, and the negative margin was obtained after the margin was taken again.There were significant differences in the age, tumor histology and tumor size between the positive margin group and the negative margin group (P＜0.05).There were not significant differences in the biopsy pattern, lymph node staging, lymph vessel vascular/neural invasion, histological grade, hormone receptor status, Her-2 status and Ki-67 status between the positive margin group and the negative margin group (P＞0.05).Multivariate Logistic regression analysis showed that age≥40 years,larger tumor diameter(T3)and invasive lobular carcinoma of tumor type were risk factors for positive margin(P＜0.05).The operation time of the positive margin group was longer than that of the negative margin group,the costs of surgery and pathological examination were higher than those of the negative margin group, and the differences were statistically significant(P＜0.05).The operation time in the second surgery was longer than that in the non-secondary surgery,the costs of surgery and pathological examination were higher than those in the non-secondary surgery, and the differences were statistically significant (P＜0.05).The total incidence rate of complications in the positive margin group was 0.4% (3/751),which was not statistically significant compared with 0.8% (6/751) in the negative margin group (P＞0.05).The results of 751 frozen pathological findings showed that 706 (94.0%) frozen pathological sections were consistent with the pathological results of paraffin.Conclusion As a means of assessing the margin in the breast conserving surgery, the frozen pathological section has the advantages of high speed and high accuracy, and the patients′ secondary operation rate is low, which can save the hospitalization costs such as operation time, operation cost and hospitalization days.However,how to further improve its accuracy and the criteria for the size of the cutting edge remains to be further explored.
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