Home Chapter Home Jobs Conferences Fellowships Books
Advertisement
Breast-nonmalignant
Procedures
Open biopsy with frozen section
Editor: Hind Nassar, M.D., Johns Hopkins Medical Institute (see Reviewers page)
Revised: 26 September 2012, last major update May 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Open biopsy - general
=========================================================================
● Perform excisional biopsies for tumors 2.5 cm or less; incisional (open) biopsies if tumors are larger
Frozen section - general
=========================================================================
● Historically, open biopsy with positive frozen section led to mastectomy
● Currently, even if frozen section is positive, there is a delay after biopsy to give the patient time to evaluate options
● First priority of open biopsy or frozen section is accurate histologic diagnosis; sufficient tissue must be obtained for permanent sections
● If frozen section is suspicious for DCIS, use all remaining tissue for permanent sections
● Don’t do frozen section if mass is 1 cm or less or if calcifications only / no mass (Cancer 1997;80:75), because the frozen block may contain artifacts and no tissue will be left for permanent sections without artifacts
● Note: this topic excludes frozen section analysis of core biopsies
Uses of frozen section
=========================================================================
● Evaluate margins (Ann Surg Oncol 2007;14:2953, World J Surg 2008;32:2599), particularly if total circumference surgical margin examination (Jpn J Clin Oncol 2010 Feb 26 [Epub ahead of print])
● Confirm a cytologic diagnosis
● Reduce rate of two stage operations (Eur J Surg Oncol 2009;35:264)
● Assess sentinel lymph nodes (World J Surg Oncol 2006;4:26, Eur J Surg Oncol 2009;35:276), but false negatives are common (Ann Surg Oncol 2010 Apr 27 [Epub ahead of print])
● Probably not helpful if specimen is grossly benign (Mod Path 1994;7:762)
Limitations of frozen section
=========================================================================
● False positives with frozen section: sclerosing lesions (radial scar, sclerosing adenosis, ductal adenoma), ductal hyperplasia, papillary lesions, fat necrosis; often cannot exclude invasion in DCIS
● False negatives with frozen section: post-chemotherapy tumor, well differentiated papillary carcinoma, lobular carcinoma, tubular carcinoma (Chin Med J (Engl) 2007;120:630); reduced with preoperative core biopsy
● Note: stereotactic and ultrasonography-guided core needle biopsies seem to be almost as accurate as open surgical biopsy, with lower complication rates (Ann Intern Med 2010;152:238)
Additional references
=========================================================================
End of Breast-nonmalignant > Procedures > Open biopsy with frozen section
This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must also be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.
All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).