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In an attempt to reduce the number of breast biopsies done for benign breast disease in patients with breast lumps, we evaluated prospectively the sensitivity and specificity of the combination of three diagnostic modalities: clinical examination, mammography, and fine-needle aspiration cytologic examination (FNA). A total of 234 patients with a breast mass had a physical examination, a mammogram, and FNA, and were listed as malignant/suspicious or benign. All patients underwent a subsequent biopsy: 110 were found to have breast cancer, and 124 had a benign lesion. The sensitivity and specificity of the individual tests were as follows: 89% and 73%, respectively, for mammographic examination; 93% and 97% for FNA cytologic examination; and 89% and 60% for physical examination. For the combined triad of tests, the sensitivity was 100% and specificity 57%. All patients who had breast cancer had positive findings for malignancy in one or more of the diagnostic tests, i.e., 100% sensitively. All patients who had negative findings for malignancy in all three diagnostic tests had benign lesions, i.e., a negative predictive value of 100%. We conclude that breast masses can be diagnosed with a high degree of accuracy by combined physical, mammographic, and fine-needle aspiration cytologic examination. Patients in whom physical examination, mammography, and FNA were negative for malignancy can be safely observed, obviating the need for an open biopsy.

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Five hundred eighty-six consecutive frozen-section consultations performed during a I-year period were studied prospectively in order to assess the accuracy of the method and develop a quality control mechanism. The overall accuracy was 97.1%. The accuracy of the method with breast lesions was 97.9%. Specimens from the gastrointestinal tract and thyroid were incorrectly interpreted in 5% of the cases. The accuracy for lymph node specimens was 96.2%, with more than 50% consulted out of curiosity. The authors conclude that frozen section of lymph node is not recommended. Most of the errors were sampling errors made by the pathologist. The authors therefore conclude that in clinically suspected malignancy, more than one sample must be examined in order to decrease the false-negative diagnosis in frozen section.Cancer 57:377-379,1986.HE FROZEN-SECTION TECHNIQUE is now a well-es-T tablished procedure for rapid diagnosis of specimens.This procedure serves the surgeon by providing diagnosis, tissue recognition, and extent of resection, and thus helps in the making of therapeutic decisions. Because the diagnosis made by the pathologist from frozen section may have serious consequences for the treatment of the patient, a high degree of accuracy is mandatory and quality control is important. The surgeon constitutes a critical component of the diagnostic effort by his selection of the tissue from which the frozen section is done. No pathologist can overcome the handicap of being handed the wrong tissue. Consequently, both the surgeon and the pathologist must be advised of the other's problems and limitations if frozen-section conclusions are to give maximum service. The current study was undertaken in order to assess the accuracy of frozen section in a routine surgical pathologic service. Materials and MethodsA prospective survey was made of all surgical specimens diagnosed by frozen section at the Pathology Institute of Meir General Hospital in the course of 1 year. During this time, 7,073 specimens were received for surgical pathologic diagnosis, 586 of which were submitted for frozen-section diagnosis also. This group was a selected one in which preoperative histologic diagnosis of cancer was not made. Specimens in which preoperative diagnosis of cancer was made with biopsy specimens were excluded. Material for frozen section received from the surgical suites is examined immediately by the pathologist. The material is frozen with the use of a standard stainless steel heat sink built into the machine (American Optical Cryostate, Buffalo, NY) and is then sectioned and stained with hematoxylin and eosin. After a few minutes of preparation, the slides are transferred to the pathologist for microscopic examination. After consultation with another senior pathologist, the final diagnosis of the frozen section is established. The rest of the specimen is then fixed and stained by a routine histopathologic technique. The final pathologic diagnoses from the paraffin-block sections were recorded separately, and at the end of this s...

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