A New Approach to Evaluating the Sub-Areolar Margin in Nipple-Sparing Mastectomies: Touch Preparation v. Frozen Section Analysis
NM Patel, L Liu, RA Goldschmidt. NorthShore University HealthSystem, Evanston, IL
Background: Nipple-sparing mastectomy (NSM) is an alternative to traditional mastectomy for patients undergoing surgery for the treatment and/or prophylaxis of breast cancer. Since the nipple-areolar complex may be involved by pathological processes, intra-operative frozen section analysis of the sub-areolar margin (SAM) is performed at our institution. This method of analysis is often time consuming due to the difficulty of cutting fatty breast tissue and the occasional necessity of multiple chucks and levels, but has a concordance of 100% with permanent section diagnosis at our institution (n=104). Intraoperative cytologic evaluation of the SAM through touch preparation (TP) is an alternative method that has not previously been examined in depth.
Design: TP of the SAM from NSM specimens were made prior to traditional frozen section analysis. All slides were then evaluated for the presence of epithelial and mesenchymal cells and benign and malignant processes. The TP and frozen section slides were then independently compared to those from permanent section to evaluate for diagnosis concordance. Preparation times for single specimen TP versus single specimen frozen sections were also calculated.
Results: Concordance of TP, frozen section, and permanent section diagnoses was 100%(n=11). Benign ductal epithelial cells were seen on all TP. Benign apocrine metaplasia was seen in 2 TP from 2 SAM with fibrocystic change. Significant amounts of mature adipose tissue were seen in 2 TP from 2 SAM with greater than 70% adipose tissue. No carcinoma or carcinoma-in-situ was identified. The average and median time to prepare TP was 4 minutes (range 3-5), as opposed to an average of 10.7 minutes and a median of 9 minutes (range 3-31, n=33) for frozen sections.
Conclusions: Our data suggests that cytologic evaluation of the SAM is a viable alternative to frozen section analysis. In addition, single specimen preparation times for TP are shorter and have less variability than those for frozen sections. We are evaluating additional SAM through TP to further characterize its diagnostic value, since a small percentage (4.5%) of patients undergoing NSM at our institution have had positive SAM.
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 257, Monday Morning