Pitfalls in Frozen Section Interpretation: A Retrospective Study of Palpable Breast Tumors

Cserni, Gábor

doi:10.1177/030089169908500104

Cited by 10 publications

(5 citation statements)

References 17 publications

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“…Collective analysis shows that among experienced cytopathologists, the false‐positive rate varies between 0% and 0.86%, with an average rate of 0.17% 2, 9, 11, 22–27. This is close to the frequence observed in our series (0.25%) that, in addition, is comparable to the false‐positive rate reported on frozen sections 28–30…”

Section: Discussionsupporting

confidence: 85%

Critical clinicopathologic analysis of 23 cases of fine-needle breast sampling initially recorded as false-positive

Klijanienko

Zajdela

Lussier

et al. 2001

Cancer

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BACKGROUND Because false‐positive cytologic diagnoses in breast tumors are rare, few cases have been reported, although their consequences may be highly detrimental to the patient. The authors report the Institut Curie's experience, by using a multidisciplinary approach. METHODS Of 9334 benign breast tumors examined preoperatively for cytologic diagnosis by fine‐needle sampling (FNS), the 23 (0.25%) FNS cases considered to be false‐positive were retrospectively reviewed and analyzed. RESULTS Tumors were situated close to the nipple in 7 cases and away from the nipple in 16 cases. Tumor stage was T0 for 1 case, T1 for 18 cases, and T2 for 4 cases. Radiologically, six tumors were classified as malignant, seven as indeterminate or suspicious, and nine as benign. Three of six tumors studied by flow cytometry were DNA aneuploid. Based on a multidisciplinary clinicopathologic review, 20 FNS cases were finally classified as false‐positive, and the remaining 3 tumors with malignant FNS and subsequent benign histology were classified as true‐positive, because local and/or metastatic progression was observed in the short term. CONCLUSIONS The authors' review suggests two categories of false‐positive cases: the first in which cytologic benign patterns are overdiagnosed, and the second in which atypical morphologic criteria were present. Nevertheless, as shown by the malignant course in three cases, patients with malignant preoperative FNS and corresponding benign histology always require close clinical follow‐up. Finally, surgical overtreatment rate could be decreased if all radiologically benign tumors with positive/suspicious FNS were subject to intraoperative frozen section examination. Cancer (Cancer Cytopathol) 2001;93:132–139. © 2001 American Cancer Society.

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Section: Discussionsupporting

confidence: 85%

Critical clinicopathologic analysis of 23 cases of fine-needle breast sampling initially recorded as false-positive

Klijanienko

Zajdela

Lussier

et al. 2001

Cancer

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“…In a series of 556 FS from the breast, Rosen reported no FPs, 3% FNs and 5.4% deferred diagnoses 27 . Others have estimated the FP rate for FS to be close to 1% and the deferred diagnosis rate to be up to 5% 28,29 …”

Section: Frozen Section As a Diagnostic Toolmentioning

confidence: 99%

Interpretation of fine needle aspiration cytology of the breast: a comparison of cytological, frozen section, and final histological diagnoses

et al. 2004

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This study examines the performance of the preliminary, on-site interpretation by the pathologist of fine needle aspiration (FNA) cytology smears compared to the final cytology report, the frozen section diagnosis and the final histopathological report. We found that both the preliminary and the final cytology reports gave satisfactory results over the minimum standards for quality assurance required by both the Norwegian breast screening programme and the NHS BSP in the UK with the exception of the 'suspicious' rate. We noted that the preliminary report had fewer false negatives (2.1%) than the final report (4.3%). We show that an unequivocal cytological diagnosis of malignancy is a reliable diagnosis, and in cases where mammography/ultrasonography and clinical examination are in agreement with FNA, frozen section examination is unnecessary. However, cases with a suspicious or equivocal FNA should be considered for frozen section analysis.

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“…Previous research showed that the diagnostic sensitivity of frozen section for ductal carcinoma in situ (DCIS) was only about 50% [8] , the main reason was that some DCIS appear as non-mass lesions, which could not be identi ed by macroscopic examination, that may be leading to sampling errors [8,9] . In our study, the diagnostic sensitivity of frozen section for pure DCIS was 50.62% (papillary carcinomas are not included), which similar to previous study.…”

Section: Discussionmentioning

confidence: 99%

“…However, its sensitivity in the diagnosis of very early breast cancer has been controversial. According to previous reports, the diagnostic accuracy of frozen section for invasive breast cancer is high [5][6][7] , but lower for carcinoma in situ [8][9][10] . So far, as far as we know, there is no study that investigated the role of frozen section in the diagnosis of CNB-undiagnosable breast cancer, therefore, its practical utility in CNB-undiagnosable breast cancer is indeterminate.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative frozen section can reduce unnecessary second operation in breast cancer patients that failed to be diagnosed by previous core needle biopsy: a retrospective analysis of Chinese clinical practice

Xue

Gong

et al. 2022

Preprint

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Objective: The value of frozen section in the intraoperative diagnosis of breast cancer that failed to be diagnosed by previous core needle biopsy (CNB) is indeterminate. To evaluate and improve the clinical utility of frozen section on this kind of breast cancer, we conducted a retrospective data analysis and constructed a prediction model.Method: We reviewed data of breast cancer patients that failed to be diagnosed by previous CNB (CNB-undiagnosable) in Fudan University Shanghai Cancer Center (FUSCC) from May 1, 2006 to December 31, 2019. Clinical characteristics of patients were collected. the correlation between clinical features and false negative rate (FNR) of frozen sections was explored with logistic regression analysis, after which a nomogram was constructed to predict the probability of false negative.Result: The diagnostic sensitivity of frozen section on CNB-undiagnosable breast cancer was 67.18%, and the FNR was 32.82%. In multivariate analysis, papillary lesion (OR, 4.251; 95% CI, 2.804-6.492; P<0.0001) and sclerosing adenosis (OR, 3.727; 95% CI, 1.897-7.376; P= 0.0001) on CNB were risk factors of false negative, while clustered microcalcifications on mammography (OR, 0.345; 95% CI, 0.216-0.543; P < 0.0001) and ultrasonic BI-RADS category 4C-5 (OR, 0.250; 95% CI, 0.081-0.777; P = 0.0157) were favorable factors of true positive. The false negative rate of frozen section could be controlled at about 11% or less by the prediction of nomogram. Conclusion: Frozen sections are valuable in the intraoperative diagnoses of CNB-undiagnosable breast cancers. It is recommended to implement the intraoperative frozen sections for high-risk breast lesions with a low probability of false negative indicated by prediction, so as to minimize the occurrence of unnecessary second operation.

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Pitfalls in Frozen Section Interpretation: A Retrospective Study of Palpable Breast Tumors

Cited by 10 publications

References 17 publications

Critical clinicopathologic analysis of 23 cases of fine-needle breast sampling initially recorded as false-positive

Critical clinicopathologic analysis of 23 cases of fine-needle breast sampling initially recorded as false-positive

Interpretation of fine needle aspiration cytology of the breast: a comparison of cytological, frozen section, and final histological diagnoses

Intraoperative frozen section can reduce unnecessary second operation in breast cancer patients that failed to be diagnosed by previous core needle biopsy: a retrospective analysis of Chinese clinical practice

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