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Intra-operative diagnosis of breast mass-lesions: comparison of the validity of touch smear preparation and frozen section techniques.

BACKGROUND
A reliable intra-operative pathological diagnosis is a mandatory before proper surgery of breast cancer. So far, The Frozen Section Technique (FS) is the standard technique with a relatively high level of validity. However, when the special facilities of FS are unavailable, Touch Smears Preparation technique (TSP) could be alternatively adopted.


OBJECTIVE
Our objective is to compare the validity of TSP in the intraoperative diagnosis of breast mass lesions, with that of FS technique. An additional aim is to determine the special advantages of both techniques.


PATIENTS AND METHODS
The study was conducted on 130 breast mass lesions, obtained from operable cases, requesting intra-operative diagnosis at the Pathology Department at the National Cancer Institute (NCI), Cairo University, during the years 2004-2007. The specimens were subjected to the two diagnostic techniques, namely: FS and TSP. Then both were examined separately, by two different observers. The results were expressed as: positive for malignancy, negative for malignancy or deferred diagnosis. The validity of each FS and TSP is tested by using the validity statistical formulas and then results of both were compared. Paraffin section was the golden standard for the true diagnosis.


RESULTS
The accuracy of FS was found to be higher than TSP (100%). Thus, a sensitivity of 100% and a specificity of 100%. Whereas, TSP had a sensitivity of 92.99%, a specificity of 93.33% and an overall accuracy of 92.5%. TSP had also a negative predictive value of 80% and the positive predictive value was 97.65%. The rate of deferred diagnosis was lower in FS (1.5%) than TSP (6.2%).


CONCLUSIONS
The study concluded that The FS is much superior to TSP in intra-operative the diagnosis of breast mass. However, when the special FS equipment is lacking, TSP could be a reliable alternative provided that an experienced cytopathologist is available. Analysis of predictive value rates revealed that a positive cytological report is more reliable than a negative one. Moreover, TSP could also be an adjuvant to FS.