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Meta-Analysis
. 2021 Mar 18;16(3):e0248768.
doi: 10.1371/journal.pone.0248768. eCollection 2021.

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

Mila Trementosa Garcia  1 , Bruna Salani Mota  1 , Natalia Cardoso  2 , Ana Luiza Cabrera Martimbianco  3 , Marcos Desidério Ricci  1 , Filomena Marino Carvalho  4 , Rodrigo Gonçalves  1 , José Maria Soares Junior  1 , José Roberto Filassi  1
Affiliations
Meta-Analysis

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

Mila Trementosa Garcia et al. PLoS One. .

Abstract

Background and objectives: 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.

Methods: 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).

Results: 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.

Conclusion: 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.

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Conflict of interest statement

No authors have competing interests.

Figures

Fig 1
Fig 1. PRISMA flowchart.
Fig 2
Fig 2. Sensitivity.
Fig 3
Fig 3. Specificity.
Fig 4
Fig 4. SROC curve.
Fig 5
Fig 5. Risk of bias by QUADAS-2.
Fig 6
Fig 6. Funnel plot of publication bias.
See this image and copyright information in PMC

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