Intraoperative assessment of the breast: guidelines and potential pitfalls

Intraoperative evaluation of breast tissue has changed as newer imaging techniques and surgical approaches to the treatment of breast cancer have placed the pathologist in a pivotal role in the management of this disease. Assessment of the index lesion and surgical margins are but two of the many tasks we face when the specimen arrives in the surgical pathology laboratory. We are also called on to correlate changes in the mammogram with the gross pathology, particularly in those cases in which the lesion is nonpalpable. More recently, pathologists have been asked to analyze 1 or more sentinel lymph nodes at the time of frozen section to look for metastatic disease. This review discusses many of these issues and also provides a simplified approach to the differential diagnosis of a variety of breast lesions one may encounter intraoperatively.

To provide guidelines for and address potential pitfalls in the intraoperative management of the breast.

Author's experience and pertinent literature.

Careful assessment of the gross specimen coupled with prudent utilization of frozen sections is pivotal to reducing intraoperative error rates and preventing needless anxiety for the patient.