Accuracy of frozen section in intraoperative margin assessment for breast-conserving surgery: A systematic review and meta-analysis

• Published in: PloS one Vol. 16; no. 3; p. e0248768
• Main Authors: Garcia, Mila Trementosa, Mota, Bruna Salani, Cardoso, Natalia, Martimbianco, Ana Luiza Cabrera, Ricci, Marcos Desidério, Carvalho, Filomena Marino, Gonçalves, Rodrigo, Soares Junior, José Maria, Filassi, José Roberto
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18-03-2021; Public Library of Science (PLoS)
• Subjects: Accuracy; Adult; Aged; Aged, 80 and over; Auroral kilometric radiation; Bias; Biology and Life Sciences; Breast cancer; Breast Neoplasms - surgery; Cancer therapies; Confidence intervals; Female; Frozen Sections; Frozen tissue sections; Gynecology; Humans; Intraoperative Care; Lumpectomy; Lymph nodes; Margins of Excision; Mastectomy; Mastectomy, Segmental; Medical ethics; Medical research; Medicine and Health Sciences; Meta-analysis; Methods; Middle Aged; Neoplasm Recurrence, Local - surgery; Obstetrics; Paraffin; Paraffins; Patient outcomes; Physical Sciences; Physiological aspects; Publication Bias; Radiation; Radiation therapy; Research and Analysis Methods; Risk; ROC Curve; Sensitivity and Specificity; Surgery; Survival; Survival Analysis; Systematic review; Young Adult; Brazil
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0248768

It is well established that tumor-free margin is an important factor for reducing local recurrence and reoperation rates. This systematic review with meta-analysis of frozen section intraoperative margin assessment aims to evaluate the accuracy, and reoperation and survival rates, and to establish its importance in breast-conserving surgery.
A thorough review was conducted in all online publication-databases for the related literature up to March 2020. MeSH terms used: "Breast Cancer", "Segmental Mastectomy" and "Frozen Section". We included the studies that evaluated accuracy of frozen section, reoperation and survival rates. To ensure quality of the included articles, the QUADAS-2 tool (adapted) was employed. The assessment of publication bias by graphical and statistical methods was performed using the funnel plot and the Egger's test. The review protocol was registered in PROSPERO (CRD42019125682).
Nineteen studies were deemed suitable, with a total of 6,769 cases. The reoperation rate on average was 5.9%. Sensitivity was 0.81, with a Confidence Interval of 0.79-0.83, p = 0.0000, I2 = 95.1%, and specificity was 0.97, with a Confidence Interval of 0.97-0.98, p = 0.0000, I-2 = 90.8%, for 17 studies and 5,615 cases. Accuracy was 0.98. Twelve studies described local recurrence and the highest cumulative recurrence rate in 3 years was 7.5%. The quality of the included studies based on the QUADAS-2 tool showed a low risk of bias. There is no publication bias (p = 0.32) and the funnel plot showed symmetry.
Frozen section is a reliable procedure with high accuracy, sensitivity and specificity in intraoperative margin assessment of breast-conserving surgery. Therefore, this modality of margin assessment could be useful in reducing reoperation rates.