Intra-operative Diagnosis of Breast Lesions by Imprint Cytology and Frozen Section with Histopathological Correlation.

INTRODUCTION: The most common malignant tumour among women is breast carcinoma. Early lesions of the breast including carcinoma are potentially curable if treated properly in the era of breast conservative therapy. For this purpose different diagnostic strategies are in practice. Intra operative Imprint Cytology (IC) and Frozen Section (FS) have a role in spite of the intense recognition of aspiration cytology in the following settings: inconclusive cytological/core biopsy findings; for evaluation of lumpectomy margins and intra operative nodal status. Both IC and FS are dependable intra operative diagnostic consultation modalities and provide accurate results in minutes thereby making appropriate therapeutic decision.

AIM: To study the IC and FS features of breast lesions with correlation of final Histopathologic (HP) diagnosis and to determine its diagnostic accuracy.

MATERIALS AND METHODS: This was a descriptive cross-sectional study conducted in the Department of Pathology, JSS Medical College, JSS University, Mysuru over a period of two years (October 2011-September 2013). A total of 62 cases of surgically resected breast specimens were evaluated for features of IC, FS and correlation with HP diagnosis. After describing gross features, representative tissue fragment was taken, three imprint smears were made and same tissue fragment was subjected to FS and later for routine HP processing. Slides prepared by IC, FS were interpreted and later correlated with HP diagnosis. Statistical analysis was done with SPSS for windows (version 16.0) by applying appropriate tests.

RESULTS: Out of 62 cases, 33(53.23%) were malignant and 29(46.77%) were benign. Sensitivity, specificity and accuracy of IC were 100%, 96.43% and 98.36% and for FS were 100%, 96.55% and 98.39% respectively. p-value for both were <0.001 indicating significant correlation with HP study.

CONCLUSION: IC is a simple, accurate, rapid and cost effective diagnostic tool intra operatively where services for FS are not available. It preserves crisp cellular and nuclear detail. FS tissue architecture strongly approximates permanent HP sections but is frequently hampered by freezing artifact. But FS is able to differentiate carcinoma in situ and infiltrative lesions from benign breast lesions. Thus, IC and FS together offer a more reliable diagnosis; hence, it is always useful to prepare both the slides intra operatively. HP study still remains the gold standard in final diagnosis of any breast lesion. In surgical pathology, the correlation of intra operative IC and FS diagnosis with the final HP diagnosis form an essential part of quality assurance activity.