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Imprint cytology of needle-localized breast lesions
A S Shabaik1, C E Cox, R A Clark
1Department of Pathology, University of South Florida Health Sciences Center, Tampa.
Insights
Intraoperative imprint cytology (IIC) offers a more accurate method for evaluating nonpalpable breast lesions during needle-localized breast biopsies (NLBBs). This technique can improve immediate clinical management compared to frozen section (FS).
Area of Science:
- Surgical Pathology
- Cytopathology
- Breast Imaging and Intervention
Background:
- Intraoperative evaluation of nonpalpable breast lesions is crucial for timely management but often limited by frozen section (FS) challenges.
- Frozen section (FS) for needle-localized breast biopsies (NLBBs) has shown limitations including tissue loss, sampling errors, and artifacts, with only 10% of NLBBs at the institution undergoing FS.
- The sensitivity of FS in a retrospective review was 88%, highlighting potential diagnostic inaccuracies.
Purpose of the Study:
- To evaluate the diagnostic accuracy of intraoperative imprint cytology (IIC) for nonpalpable breast lesions.
- To assess the potential clinical role of IIC in facilitating single-stage, cost-effective management of NLBBs.
- To compare the efficacy of IIC with traditional frozen section (FS) in intraoperative breast lesion assessment.
Main Methods:
- A retrospective review of 88 nonpalpable breast lesions evaluated by intraoperative imprint cytology (IIC) and permanent histology.
- Fifteen of these lesions were also assessed concurrently using frozen section (FS) for comparative analysis.
- Diagnostic accuracy was determined by comparing IIC and FS results against definitive permanent histology.
Main Results:
- Intraoperative imprint cytology (IIC) demonstrated high accuracy, with all but one deferred diagnosis being correct.
- Frozen section (FS) evaluation of 15 lesions yielded correct diagnoses in 12 cases, with 2 deferred and 1 false negative result.
- IIC showed a higher diagnostic yield and fewer deferred diagnoses compared to FS in this cohort.
Conclusions:
- Intraoperative imprint cytology (IIC) is a valuable tool for the intraoperative evaluation of nonpalpable breast lesions.
- IIC may overcome the limitations associated with frozen section (FS), enabling immediate clinical decisions.
- This technique supports efficient patient management by allowing prompt intervention and subsequent definitive histologic analysis.
Abstract:
Intraoperative evaluation of nonpalpable breast lesions by frozen section frequently is not performed because of potential tissue loss, sampling errors and frozen section artifacts. In a retrospective review we found that only 50 of 503 needle-localized breast biopsies (NLBBs) were evaluated at our institution by frozen section (FS), with a sensitivity of 88%. However, intraoperative evaluation of such lesions may be essential to single-stage and cost-effective management. To this end, this study evaluated the diagnostic accuracy and potential clinical role of intraoperative imprint cytology (IIC) in NLBB. A total of 88 lesions were evaluated by IIC and permanent histology. Fifteen of them were also concomitantly evaluated by FS. All but one deferred cytologic diagnoses were correct. Twelve of 15 FS diagnoses were correct, 2 were deferred, and 1 was false negative. The data suggest that IIC may circumvent some of the difficulties associated with FS, thereby allowing immediate clinical management and later definitive histologic typing and evaluation of prognostic parameters in nonpalpable breast lesions.