title: Accuracy of frozen section diagnoses of breast lesions after introduction of a national programme in mammographic screening.
abstract: OBJECTIVE
  By introducing mammography screening programmes, the size of the detected breast lesions became smaller and the histopathological interpretation problems greater. The study's aim was to analyse the risks and possible limitations of the frozen section method.
  
  
  RESULTS
  Frozen section consultations of breast lesions (n=559) 2 years before and 6 years after launching a national mammographic screening programme in 1992 were evaluated in regard of the benign/malignant ratio, tumour size, preoperative frozen section results and final permanent section diagnoses. The breast frozen section examinations of 1990 compared with those from 1998 declined from 70.7% (299/423) to 62.2% (260/418) (P < 0.01), the benign/malignant ratio from 1.09 to 0.54 (P < 0.0001), the rate of the conclusive, correct frozen section diagnoses from 96.3% to 91.9% (P < 0.03). The sensitivity dropped from 92.3% to 87.6%, the negative predictive value from 95.7% to 88.3%, whereas the negative likelihood ratio rose from 0.08 to 0.12. The 'small' (< or = 10 mm) invasive breast carcinomas increased from 14.2% to 22.3% (P < 0.01) and the 'in situ' carcinomas from 2.1% to 6.6% (P < 0.05).
  
  
  CONCLUSIONS
  The declining sizes of breast tumours (< or = 10 mm), especially from radiologically detected lesions and sometimes without a macroscopic correlate, create new limitations and changing indications in the histopathological interpretation. Considering the performance of new diagnostic methods (i.e. large core needle biopsies), frozen sections of surgical specimens should not be the primary diagnostic procedure for breast lesions and should be performed only after other preoperative methods have failed.
authors.affiliation: Division of Pathology, National Health Laboratory, Luxembourg, Belgium. pathologie@lns.etat.lu
authors.forename: R
authors.initials: R
authors.lastname: Scheiden
authors.forename: J
authors.initials: J
authors.lastname: Sand
authors.forename: A M
authors.initials: AM
authors.lastname: Tanous
authors.forename: U
authors.initials: U
authors.lastname: Knolle
authors.forename: C
authors.initials: C
authors.lastname: Capesius
authors.forename: M C
authors.initials: MC
authors.lastname: Wagnon
authors.forename: D
authors.initials: D
authors.lastname: Faverly
mesh_terms: D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000175:diagnosis*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005629:Frozen Sections / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D009313:National Health Programs; D016612:Paraffin Embedding / Q000592:standards / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D013997:Time Factors