title: Accuracy of frozen section, imprint cytology, and permanent histology of sub-nipple tissue for predicting occult nipple involvement in patients with breast carcinoma.
abstract: The sub-nipple tissue (SNT) examination has been used by surgeons to preserve, or not, the nipple in nipple-sparing mastectomy. However, it is uncertain whether SNT evaluation can predict nipple involvement. The aim of this study was to evaluate the accuracy, sensitivity, specificity, PPV, and NPV of the intraoperative frozen section and imprint cytology, and permanent histology of SNT to predict the involvement of the nipple in breast carcinoma and to compare the three exams. A prospective study was performed with 68 consecutive breast carcinoma women who had undergone mastectomy or central segmentectomy (removing nipple-areolar complex). After surgery, the nipple-areolar complex was dissected simulating a nipple-sparing flap (ex vivo). The SNT was subsequently removed and submitted to frozen section, imprint cytology, and permanent histology. The nipple was examined separately by paraffin histopathology and was considered the gold standard. The occult nipple involvement rate was 11.7 %. The frozen section, cytology, and permanent histology of SNT presented accuracy 86.8, 76.5, and 86.8 %; sensitivity 50, 37.5, and 62.5 %; specificity 91.7, 81.7, and 90 %; PPV 44.4, 21.4, and 45.5 %; and NPV 93.2, 90.7, and 94.7 %, respectively. The accuracy of the frozen section was similar to that of permanent histology (p = 0.77) and both were better than cytology (p = 0.01). False negative rates were 6.8 % for frozen section, 9.3 % for cytology and 5.3 % for paraffin. SNT evaluation is a good method for predicting occult nipple involvement; the outcomes showed a good accuracy and low false negative rate for the frozen section, cytology, and permanent histology exams. When we compared the exams, the frozen section was similar to permanent histology and more accurate than imprint cytology.
authors.affiliation: Women's Hospital Prof. Dr. José Aristodemo Pinotti, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Campinas, SP, 13083-881, Brazil. giuliano.duarte@ig.com.br.
authors.forename: Giuliano M
authors.initials: GM
authors.lastname: Duarte
authors.affiliation: Women's Hospital Prof. Dr. José Aristodemo Pinotti, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Campinas, SP, 13083-881, Brazil.
authors.forename: Maria Virginia
authors.initials: MV
authors.lastname: Tomazini
authors.affiliation: Women's Hospital Prof. Dr. José Aristodemo Pinotti, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Campinas, SP, 13083-881, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: Oliveira
authors.affiliation: Women's Hospital Prof. Dr. José Aristodemo Pinotti, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Campinas, SP, 13083-881, Brazil.
authors.forename: Luciana
authors.initials: L
authors.lastname: Moreira
authors.affiliation: Women's Hospital Prof. Dr. José Aristodemo Pinotti, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Campinas, SP, 13083-881, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Tocchet
authors.affiliation: Women's Hospital Prof. Dr. José Aristodemo Pinotti, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Campinas, SP, 13083-881, Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Worschech
authors.affiliation: Women's Hospital Prof. Dr. José Aristodemo Pinotti, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Campinas, SP, 13083-881, Brazil.
authors.forename: Renato Z
authors.initials: RZ
authors.lastname: Torresan
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008327:Mammography; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D009558:Nipples / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods / Q000592:standards; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor
keywords: Accuracy; Breast carcinoma; Nipple; Nipple-sparing mastectomy