Korean Journal of Clinical Laboratory Science (대한임상검사과학회지)

Korean Society for Clinical Laboratory Science (대한임상검사과학회)
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A Study on the Quality of a Frozen Section of Breast Resection Margin during Breast-Conserving Surgery

유방 보존술 중 절제면 동결절편검사의 질 향상에 관한 연구

  • Choi, Byung-Il (Department of Pathology, Soonchunhyang University Hospital) ;
  • Chin, Su-Sie (Department of Pathology, Soonchunhyang University Hospital)
  • 최병일 (순천향대학교 부천병원 병리과) ;
  • 진수지 (순천향대학교 부천병원 병리과)
  • Received : 2021.06.07
  • Accepted : 2021.07.07
  • Published : 2021.09.30
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Abstract

Evaluation of the resected margins of the frozen section during breast-conserving surgery can determine the presence of cancer cells in a short time and have a significant impact on the scope of surgery and the prognosis of the patient. However, breast tissue is composed of adipose tissue, which affects the accuracy of the test. In this study, a new method was applied to the resected surface of the frozen section in which wiping the surface of the frozen section block with alcohol was expected to expose the parenchyma to the surface as the adipose tissue would melt momentarily. Indeed, of the total of 98 cases, 37 cases showed a better exposure ratio of the parenchyma in the improved frozen section test than in the previous frozen section test. Of the 37 cases with increased visibility of parenchymal sections obtained by this method, two cases of ductal carcinoma in situ (DCIS) were detected. Although there are limitations such as turnaround time (TAT), the diagnostic accuracy of histopathologic examination of the frozen section may improve through this method and may have a direct impact on patient safety, and should therefore be researched further.

유방 보존술 중 절제면 동결절편검사는 빠른 시간 내에 암세포의 유무를 판단하고 환자의 수술 범위 및 예후에 중요한 영향을 미친다. 그러나 유방조직의 특성상 많은 지방조직으로 구성되어 있고, 지방조직의 양에 따라 유방조직 동결절편검사의 정확도에 많은 영향을 미칠 수 있다. 이에 본 연구에서는 유방 보존술에서 시행하는 절제면 동결절편검사에 새로운 방법을 적용하여 기존의 동결절편검사와 비교 분석하였다. 동결절편블록의 표면을 알코올로 닦아내면 지방조직이 순간적으로 용해되면서 실질조직이 표면으로 노출될 것이라 예상하였다. 실제로 총 98례 중 기존의 동결절편검사보다 개선된 동결절편검사에서 더 높은 실질조직 비율을 얻는 경우는 37례였다. 또한 개선된 동결절편검사에서 더 높은 실질조직 비율을 얻은 37례 중 이전의 동결절편검사에서는 음성으로 진단되었으나, 개선된 동결절편검사와 영구표본조직 슬라이드에서 관상피내암으로 진단이 나온 경우는 2례였다. 비록 turn around time (TAT) 등의 한계점이 존재하지만, 본 연구 결과의 적용에 대한 논의를 계속한다면 동결절편검사 시 조직학적 병리검사의 진단 정확성을 재고할 것이라고 사료되며, 환자 안전에도 직접적인 영향을 미칠 것이라고 판단된다.

Keywords

Acknowledgement

This article is article is based on a part of the first author's master's (doctoral) thesis from University.

References

  1. Kim HJ, Park WC, Park KS, Jeong SS. Frozen section diagnosis of breast lesions. J Korean Surg Soc. 2002;63:445-448.
  2. Li R, Lan L, Xia Y, Wang P, Han LK, Dunnington GL, et al. High-speed intraoperative assessment of breast tumor margins by multimodal ultrasound and photoacoustic tomography. Med Devices Sens. 2018;1:e10018. https://doi.org/10.1002/mds3.10018
  3. Karve PV, Jambhekar NA, Desai SS, Chinoy RF. Role of frozen section evaluation in patients with breast lumps: a study of 251 cases. Indian J Surg. 2005;67:241-245.
  4. Kim YJ, Chun YK, Hong SR, Kim HS, Kang SS, Lee JH, et al. Usefulness of frozen section examination of core needle biopsy in the breast carcinoma. Korean J Pathol. 2002;36:163-166
  5. Hisada T, Sawaki M, Ishiguro J, Adachi Y, Kotani, H, Yoshimura A, et al. Impact of intraoperative specimen mammography on margins in breast-conserving surgery. Mol Clin Oncol. 2016; 5:269-272. https://doi.org/10.3892/mco.2016.948
  6. Scopa CD, Melachrinou M, Panagiotopoulou C, Grekou AN. Frozen section diagnosis: a quality control study. Int Surg. 1990;75:195-197.
  7. Arora HL, Solanki RL, Gupta R. Evaluation of cryostat frozen section in the diagnosis of surgical biopsies. Indian J Pathol Microbiol. 1991;34:136-139.
  8. Kim JH, Han W, Moon HG, Ko E, Lee JW, Kim EK, et al. Factors affecting the ipsilateral breast tumor recurrence after breast conserving therapy in patients with T1 and T2 tumors. J Breast Cancer. 2009;12:324-330. https://doi.org/10.4048/jbc.2009.12.4.324
  9. Thill M, Roder K, Diedrich K, Dittmer C. Intraoperative assessment of surgical margins during breast conserving surgery of ductal carcinoma in situ by use of radiofrequency spectroscopy. Breast. 2011;20:579-580. https://doi.org/10.1016/j.breast.2011.08.134
  10. Jorns JM, Visscher D, Sabel M, Breslin T, Healy P, Daignaut, S, et al. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center. Am J Clin Pathol. 2012;138:657-669. https://doi.org/10.1309/AJCP4IEMXCJ1GDTS
  11. Cendan JC, Coco D, Copeland EM 3rd. Accuracy of intraoperative frozen-section analysis of breast cancer lumpectomy-bed margins. J Am Coll Surg. 2005;201:194-198. https://doi.org/10.1016/j.jamcollsurg.2005.03.014
  12. Sato Y, Mukai K, Watanabe S, Goto M, Shimosato Y. The AMeX method. A simplified technique of tissue processing and paraffin embedding with improved preservation of antigens for immunostaining. Am J Pathol. 1986;125:431-435
  13. Althoubaity FK, Merdad A, Akeel, NY, Zaidi NH, Sultan AO. Frozen section analysis of breast lumpectomy margins. Surgical Science. 2017;8:269-227. https://doi.org/10.4236/ss.2017.86029
  14. Brender E, Burke A, Glass RM. Frozen section biopsy. JAMA. 2005;294:3200. https://doi.org/10.1001/jama.294.24.3200
  15. Bae YK. Methods of margin assessment in breast conserving surgery. Yeungnam Univ J Med. 2007;24:262-269. https://doi.org/10.12701/yujm.2007.24.2S.S262
  16. Rosene DL, Rhodes KJ. Cryoprotection and freezing methods to control ice crystal artifact in frozen sections of fixed and unfixed brain tissue. Methods in Neurosciences. 1990;3:360-385. https://doi.org.10.1016/B978-0-12-185255-9.50026-2