Accuracy and Reliability of Frozen Section Diagnosis in a Series of 672 Nonpalpable Breast Lesions

Abstract

Frozen section (FS) diagnosis was routinely performed in a large series of nonpalpable breast lesions from 1977 through 1991. The original FS diagnoses of 672 patients were classified in four categories (1 = benign lesion, 2 = in situ carcinoma, 3 = invasive carcinoma, 4 = deferred diagnosis) and compared with the diagnoses obtained at review of the permanent paraffin sections to estimate the accuracy of FS. A review of the mammographic pattern of the lesion was also performed. Frozen section diagnostic conclusion was deferred to permanent paraffin sections in only 22 cases (3.3%). Benign or malignant (grouping in situ and invasive carcinomas) FS diagnoses were accurate in 623 of 650 cases (95.8%). Overall, the prevalence of malignant lesions was 44.8% with a benign/malignant ratio of 1.2. The diagnosis was modified on the basis of permanent sections in 27 cases (4.2%) with three false positives and 24 false negatives. Sensitivity and specificity of FS diagnoses were 91.7 and 99.2%, respectively. When the comparison between FS and histologic diagnoses was analyzed according to the mammographic pattern, sensitivity among patients with microcalcifications as the only alteration was lower (88.8%) than among patients with opacities (94.9%). On the basis of these results, FS is to be considered a feasible and reliable diagnostic procedure in nonpalpable breast lesions, particularly in cases excised because of a mammographic opacity that is identifiable on gross examination of the surgical specimen.

Breast Carcinosarcomas

“…Frozen section examination has high sensitivity (90%) and specificity (99%) rates in breast masses (17,18). However, in some cases with breast carcinosarcoma, a small piece of the tumor sent for frozen section examination may not be sufficient to reveal the overall profile of the tumor (19).…”

Intraoperative Frozen Section for Margin Assessment in Breast Conserving Surgery

“…In our study,s ensitivity and specificity was 100%. Data from the literature report that the percentage of false-positive frozen section diagnoses of breast lesions varies from 0% to 0.4%, and the rate of falsenegative diagnoses varies from 0.5% to 3.4% (22,23,25). Some authors claimed that the use of frozen section in smaller specimens causes loss of tissue for permanent section, and frozen section has sampling errors and artefacts related to fat or calcifications (10,11,23,26).…”

Validez diagnóstica de la biopsia intraoperatoria en cirugía de lesiones mamarias palpables

“…La sensibilidad y especificidad de la BIO en lesiones no palpables varía según lo señalado en la literatura con una sensibilidad entre 80% y 91,7% y una especificidad entre 69% y 99% [19][20][21] . Con lesiones de menor tamaño se podrá disminuir el número de mastectomías totales en favor de tumorectomías con disección axilar dirigida con la BIO del ganglio centinela 22 .…”