The results of intraoperative consultations in 181 ductal carcinomas in situ of the breast

Liu, Cheng; Al‐Kaisi, Nadia K.; Liu, Alison Y.; Gordon, Nahida H.

doi:10.1002/(sici)1097-0142(19970701)80:1<75::aid-cncr10>3.3.co;2-1

Cited by 4 publications

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“…The following factors were found to contribute to the pitfalls and misinterpretations: 1) misinterpretation (insufficient expertise), 2) poor quality of the FS (artifacts making diagnosis difficult), 3) sampling errors during sectioning, 4) ignorance of macroscopic features, 5) lesions difficult to interpret (hard cases), 6) ductal carcinoma in situ (DCIS) as the only lesion in the specimen, and 7) sections not deep enough (focal nature of the lesion). Several of the factors were often present together ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

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

Cserni

1999

Tumori

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Although the number of errors is relatively low, more stress should be placed on the preoperative diagnosis of breast lesions. Breast surgery frozen section should be used as rarely as possible for diagnostic purposes, despite the generally good diagnostic accuracy. However, it is reasonable to use frozen sections widely until the given preoperative diagnostic tools allow an appropriate preoperative workup, because it is the only way to keep histopathologists trained to interpret frozen sections.

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Section: Resultsmentioning

confidence: 99%

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

Cserni

1999

Tumori

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“…However, FSA requires increased surgical time and has reduced accuracy compared with paraffinembedded histology (15)(16)(17)(18)(19). FSA studies have reported sensitivities between 65% and 91% and specificities between 85% and 100% (16,17,(20)(21)(22)(23), and false-negative rates as high as 36% for small (<1 cm) or nonpalpable lesions, such as DCIS (24). FSA is particularly difficult in fatty breast specimens, and freezing artifacts make subsequent diagnosis on paraffin-embedded sections more difficult (25,26).…”

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confidence: 99%

Assessment of breast pathologies using nonlinear microscopy

Tao

Shen

Sheikine

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

191

161

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Rapid intraoperative assessment of breast excision specimens is clinically important because up to 40% of patients undergoing breast-conserving cancer surgery require reexcision for positive or close margins. We demonstrate nonlinear microscopy (NLM) for the assessment of benign and malignant breast pathologies in fresh surgical specimens. A total of 179 specimens from 50 patients was imaged with NLM using rapid extrinsic nuclear staining with acridine orange and intrinsic second harmonic contrast generation from collagen. Imaging was performed on fresh, intact specimens without the need for fixation, embedding, and sectioning required for conventional histopathology. A visualization method to aid pathological interpretation is presented that maps NLM contrast from two-photon fluorescence and second harmonic signals to features closely resembling histopathology using hematoxylin and eosin staining. Mosaicking is used to overcome trade-offs between resolution and field of view, enabling imaging of subcellular features over square-centimeter specimens. After NLM examination, specimens were processed for standard paraffin-embedded histology using a protocol that coregistered histological sections to NLM images for paired assessment. Blinded NLM reading by three pathologists achieved 95.4% sensitivity and 93.3% specificity, compared with paraffin-embedded histology, for identifying invasive cancer and ductal carcinoma in situ versus benign breast tissue. Interobserver agreement was κ = 0.88 for NLM and κ = 0.89 for histology. These results show that NLM achieves high diagnostic accuracy, can be rapidly performed on unfixed specimens, and is a promising method for intraoperative margin assessment.nonlinear microscopy | breast cancer | pathology | imaging B reast cancer is the most common cancer and cause of cancerrelated death in women worldwide (1). In the United States, one in eight women will develop breast cancer in their lifetimes with an estimated 226,870 new cases and 39,510 deaths in 2012 (2). Breast-conserving therapy (BCT), lumpectomy followed by adjuvant radiation and/or chemotherapy and hormonal therapy, is a standard of care for early breast cancer and achieves survival and local recurrence rates comparable to mastectomy while providing superior cosmetic outcomes and reduced morbidity (3-5). Local recurrence rates are correlated with surgical margin status, which is evaluated using intraoperative examination and postoperative histopathology. However, there is no consensus on surgical margin widths, and differing conventions for negative and close margins have shown inconsistent correlations with therapeutic outcomes (6-9). Despite these inconsistencies, margins initially positive for invasive cancer or ductal carcinoma in situ (DCIS) almost always require surgical reexcision (92.6% when positive for DCIS and 83.5% when positive for invasive cancer) (9), and up to 40% of all women undergoing BCT require repeat surgeries from positive or close margins (10-12). In addition to surgical complications and incr...

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“…Certainly, the accuracy of diagnosing DCIS by frozen section has been questioned in several series. 160,161 Even for small and low-grade cancers, the source of many equivocal needle biopsy results, frozen section diagnosis may not be completely reliable. Even when the diagnosis of cancer by needle biopsy is secure, definitive excision and full assessment of the size and histopathology of nonpalpable T1a and selected T1b cancers by paraffin section, as previously discussed, best enables an appropriate decision on whether additional surgery, such as sentinel lymphadenectomy, should be performed.…”

Section: Should Frozen Section Diagnoses Be Obtained For Nonpalpable mentioning

confidence: 99%

Surgery for Breast Cancer

Roses¹,

Giuliano²

2005

Breast Cancer

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The results of intraoperative consultations in 181 ductal carcinomas in situ of the breast

Cited by 4 publications

References 0 publications

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

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

Assessment of breast pathologies using nonlinear microscopy

Surgery for Breast Cancer

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