title: Improved frozen section examination of the retroareolar margin for prediction of nipple involvement in breast cancer.
abstract: BACKGROUND
  In this prospective ex vivo study, we propose a new technique for the intraoperative examination of retroareolar tissue and describe both surgical excision and pathological methods. We performed a nipple-sparing mastectomy simulation in patients selected to total mastectomy, in order to evaluate the accuracy of these new technique.
  
  
  METHODS
  A total of 158 total mastectomy specimens from patients affected by ductal carcinoma in situ (n = 15) or invasive ductal carcinoma (stages I, II, or IIIA) (n = 143) were examined. To obtain the entire sample area, the terminal retroareolar milk duct bunch was isolated. Fragments approximately 1.5 cm in length were excised and sectioned in parallel at the base of the nipple using a cold bistoury. Three transverse histological sections (4 μm each) at 200 μm intervals that included the entire isolated fragments were subjected to frozen section examination. The sections were stained with hematoxylin-eosin and were evaluated. The remainder of each fragment was embedded in paraffin and 4 μm sections were subsequently stained with hematoxylin-eosin and examined.
  
  
  RESULTS
  There were two false-negative (1.3%) and five false-positive (3.1%) findings among the frozen and paraffin sections analyzed. A statistical analysis of the frozen section examinations showed a sensitivity of 92.0%, a specificity of 96.2%, a positive predictive value of 82.1%, a negative predictive value of 98.4%, and an accuracy of 95.4%.
  
  
  CONCLUSIONS
  The frozen section examination technique described here detected nipple involvement in breast cancer with greater accuracy than the frozen section usually performed by most surgeons.
authors.affiliation: Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil.
authors.forename: J R
authors.initials: JR
authors.lastname: Morales Piato
authors.affiliation: Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil.
authors.forename: F N
authors.initials: FN
authors.lastname: Aguiar
authors.affiliation: Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil.
authors.forename: B S
authors.initials: BS
authors.lastname: Mota
authors.affiliation: Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil.
authors.forename: M D
authors.initials: MD
authors.lastname: Ricci
authors.affiliation: Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil. Electronic address: maira_doria@yahoo.com.br.
authors.forename: M T
authors.initials: MT
authors.lastname: Dória
authors.affiliation: Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil.
authors.forename: R D
authors.initials: RD
authors.lastname: Alves-Jales
authors.affiliation: Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil.
authors.forename: A P
authors.initials: AP
authors.lastname: Messias
authors.affiliation: Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil.
authors.forename: J R
authors.initials: JR
authors.lastname: Filassi
authors.affiliation: Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil.
authors.forename: E C
authors.initials: EC
authors.lastname: Baracat
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D005260:Female; D005629:Frozen Sections; D006801:Humans; D015414:Mastectomy, Subcutaneous / Q000379:methods; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods*; D009558:Nipples / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies
keywords: Breast cancer; Frozen serial sections; Prediction of papilla involvement