PT - JOURNAL ARTICLE AU - Daniel Luo AU - Jennifer Ha AU - Bruce Latham AU - David Ingram AU - Tony Connell AU - Diana Hastrich AU - Weng-Chan Yeow AU - Peter Willsher AU - Joseph Luo TI - The Accuracy of Intraoperative Subareolar Frozen Section in Nipple-Sparing Mastectomies DP - 2010 Sep 21 TA - Ochsner Journal PG - 188--192 VI - 10 IP - 3 4099 - http://www.ochsnerjournal.org/content/10/3/188.short 4100 - http://www.ochsnerjournal.org/content/10/3/188.full SO - Ochsner J2010 Sep 21; 10 AB - Background: Intraoperative subareolar frozen sections are used to assess the nipple areolar complex's suitability for preservation for patients selected for nipple-sparing mastectomy. We aim to investigate the accuracy and value of the frozen section compared to formal histopathologic results.Methods: In our 5-year retrospective study, 52 candidates for nipple-sparing mastectomies had subareolar frozen sections analyzed intraoperatively for malignant or atypical duct changes. Women were considered for nipple-sparing mastectomy if their primary breast malignancy was greater than 3 cm from the nipple-areolar complex and not multifocal in nature. Frozen-section results were compared to the formal histopathologic results, allowing analysis of the sensitivity, specificity, and predictive value. Causes of false negatives (negative frozen-section findings, positive histopathology findings) were then examined.Results: Of 52 frozen sections, 47 (90%) yielded negative results and 5 (10%) yielded positive results. Of the 47 negative results, 39 were true negatives while 8 were false negatives. Of the 5 positive results, all were true positives with no false positives. Therefore, the positive predictive value of subareolar frozen section is 100%, negative predictive value 83%, sensitivity 38%, and specificity 100%. Of the 8 false negatives, 4 (50%) were due to sampling errors, 3 (37.5%) were due to interpretation errors, and 1 (12.5%) was due to diathermy artifact.Conclusion: Intraoperative subareolar frozen section is a specific but nonsensitive test. It is useful in nipple-sparing mastectomy because in 10% of cases a positive result allows immediate nipple and areolar excision. Its low sensitivity and negative predictive value means that 15% of patients will need a subsequent nipple and areolar excision. Eighty-five percent of patients can, however, have a single-stage excision.