The Value Of Frozen Section In Diagnosis Of Intraductal Papillary Neoplasms And The Analyses Of Relevant Factors

Background:The common feature characterizing papillary lesions is a papillary, arborescent epithelial proliferation supported by fibrovascular stalks with or without an intervening myoepithelial (ME) cell layer. According to the 2012 version of 《WHO classification of tumours of the breast》,IDPN include intraductal papilloma, intraductal papillary carcinoma, encapsulated papillary carcinoma and solid papillary carcinoma. With the increasing incidence of IDPN, especially intraductal papilloma gradually become the second largest breast benign tumor after breast fibroadenoma. But because of the classification of the pathological histology of IDPN is very complicated, the clinical diagnosis and the choice of surgical options is difficult to IDPN. Intraoperative frozen section was first applied in the pathological diagnosis of breast tumor in 1891 by William h. Welch.Intraoperative frozen section is an essential approach to provide patients intraoperative pathological information and has been become the important basis of clinically decision of the operation. Some literatures reports the accuracy rate of frozen section can up to 98.6%-99.1%,but the accuracy for the diagnosis of IDPN of frozen section is rarely reported.Objective:To investigate the value of intraoperative frozen section in the diagnosis of Intraductal Papillary Neoplasms and relevant influence factors.Methods:From Jan 2007 to Dec 2013,560 patients with intraductal papillary neoplasms confirmed with postoperative paraffin pathology in Department of Breast Surgery, Qilu Hospital of Shandong University were retrospectively analyzed. The results of intraoperative frozen section and postoperative paraffin section findings were compared and factors affecting the diagnose accuracy rate were studied.Results:1. The overall accuracy rate of intraoperative frozen section was 85.1%. The accuracy rate of Intraductal papilloma and Intraductal Papillary carcinoma was 88.9% and 49.0%,respectively(p<0.001).2.The accuracy rate with or without atypical hyperplasia of Intraductal papilloma was 75.0% and 89.8%, respectively (p=0.015).3.16 cases(3.1%) with pathological grade higher and 1 case (0.2%) lower were observed.4.The precision rate with or without nipple discharge was 89.2% and 79.4%, respectively (p=0.004).Conclusions:Intraoperative frozen section has high accuracy for the diagnosis of Intraductal Papillary Neoplasms and it has advantages to decrease the rate of second operation compared with the core needle biopsy. The accuracy rate of Intraductal papilloma is higher than Intraductal Papillary carcinoma and the precision rate is higher in Intraductal papilloma patients with atypical hyperplasia than those without atypical hyperplasia. The accuracy rate of patients with nipple discharge is higher than those without nipple discharge.