Frozen sections in decision-making regarding the axillary procedures in breast conserving surgery for intraductal carcinoma at preoperative diagnosis

Abstract Background Axillary evaluation is unnecessary for pure ductal carcinoma in situ (DCIS); however, it is performed because of upstaging risks. Purpose of this study is to decrease the upstaging rate to invasive cancer and unnecessary axillary evaluation in patients with preoperative DCIS. Methods We reviewed patients with preoperative DCIS who underwent breast-conserving surgery (BCS) with IOF biopsy. Positive Intra-operative frozen section (IOF) biopsy findings were defined as the presence of invasive or micro-invasive cancer. The IOF biopsy and permanent pathology findings were compared. Result Seventy-eight patients underwent BCS with IOF biopsy. Six patients showed positive IOF biopsy findings; five of these patients showed concordant permanent pathology findings. Sentinel lymph node biopsy (SLNB) was positive in one patient. Thirteen patients with invasive breast cancer were not diagnosed with IOF biopsy; they underwent SLNB during the second surgery. None of them had metastatic lymph nodes. The sensitivity and specificity of IOF biopsy were 27.7% and 98.3%, respectively, with 82.1% accuracy. None of the other factors showed statistically significant relationships with the permanent pathology findings, except for the IOF biopsy findings. Conclusion IOF evaluation can aid in detecting the invasiveness of tumors in patients with preoperative DCIS.