Diagnosis of breast lesions on frozen section and its cyto-histopathological correlation
Keywords:Palpable breast lesions; FNAC; Frozen section; Histopathology.
Aim: To compare the finding of frozen section with findings of FNAC and histopathology & study the sensitivity, specificity and predictive value of frozen section biopsy. Methods: A hospital based cross sectional study was done to compare the finding of frozen section with findings of FNAC and histopathology. This research included total 70 female patients of age group 11-80 years clinically presenting with palpable breast lesions referred to the Department of Pathology, for FNAC, frozen section and histopathological evaluation and a prospective study was conducted. FNAC procedure was performed according to the standard protocol. Only diagnosed cases were included in the study. Cases did not undergo surgery were excluded from the study. Results: Following FNAC, out of the total 70 cases, 35 (50%) patients had benign breast lesions while 35 (50%) patients had malignant breast lesions. Following Frozen Section, out of the total 70 cases, 33 cases (47.1%) were benign lesions and 37 cases (52.9%) were malignant. According to The histopathological diagnosis of breast lesions noted that 32 (45.7%) patients had benign breast lesions while 38 (54.3%) patients had malignant breast lesions. Frozen section findings correlated with the histopathological findings in 69 of 70 cases (98.6%), which included 32 of 32 (100%) of the benign lesions and 37 of 38 (97.4%) of the malignant lesions. 1 case of malignant lesion was wrongly diagnosed as benign on frozen section findings. The correlation of frozen section and histopathological findings was found to be statistically significant as per Chi-Square test (p<0.05). FNAC findings correlated with the histopathological findings in 65 of 70 cases (92.9%), which included 31 of 32 (96.9%) of the benign lesions and 34 of 38 (89.5%) of the malignant lesions. 1 case was wrongly diagnosed as malignant on FNAC findings while 4 cases were wrongly diagnosed as benign. The correlation of FNAC and histopathological findings was found to be statistically significant as per Chi-Square test (p<0.05). The Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of Frozen section were 97.37%, 100%, 100% and 96.97% respectively. Accuracy of Frozen section was 98.57%. It was observed that frozen section was more accurate than FNAC with higher sensitivity (97.37% vs. 89.47%), specificity (100% vs. 96.88%), PPV (100% vs. 97.14%), NPV (96.97% vs. 88.57%) and accuracy (98.57% vs. 92.86%). Conclusion: Despite increasing popularity and undisputed utility of FNAC, there are cases where frozen section still stands out as the method of choice for rapid diagnosis mainly for determining the resection margins of the lesion and the extent of metastasis in case of malignant lesion to ensure no residual tumour mass thus helping in further treatment and follow-up of patients. Final histopathological study is required to accurately arrive at a definitive diagnosis along with IHC marker study which is considered as a gold standard for patient care.
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Copyright (c) 2022 Shabina Naznin Haqiqullah, Nadeem Ahmad, Malik Atiur Rehman
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