Breast malignant, males, children
Miscellaneous
Frozen sections

Author: Emily S. Reisenbichler, M.D. (see Authors page)

Revised: 2 October 2017, last major update September 2017

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: Breast malignant [title] frozen sections

Related topics: Sentinel lymph nodes
Cite this page: Reisenbichler, E. S. Frozen sections. PathologyOutlines.com website. http://pathologyoutlines.com/topic/breastmalignantfrozensections.html. Accessed November 22nd, 2017.
Definition / general
Essential features
  • Frozen section introduces histologic artifacts: (a) alteration of architectural features makes benign lesions such as sclerosing adenosis more closely mimic invasive carcinoma; (b) artifactual clefting / spaces around tumor cells simulates lymphovascular invasion (Arch Pathol Lab Med 2005;129:1565)
  • Use of frozen section for sentinel lymph node assessment has declined following American College of Surgeons Oncology Group Z0011 trial findings (Arch Pathol Lab Med 2016;140:830, Am J Clin Pathol 2016;146:57)
  • Frozen section has been shown to be highly sensitive (86%) and specific (96%) in a meta-analysis of intraoperative breast margin assessment (Ann Surg 2017;265:300)
  • Frozen section use should be considered for margin assessment if reoperation rates at an institution are > 15% (Ann Surg Oncol 2017 Jan 5 [Epub ahead of print])
Clinical features
  • Use of frozen section to intraoperatively assess breast margins has reduced reoperative rates at selected institutions by 12.3% (Eur J Surg Oncol 2017;43:1273)
  • Frozen section use on margins for invasive lobular carcinomas or for those with extensively close margins may not significantly lower subsequent breast operations (Eur J Surg Oncol 2017;43:1273)
  • Frozen assessment of margins for DCIS has shown mixed results in the effect on reoperative rates (Breast Cancer (Auckl) 2016;10:205, Ann Surg Oncol 2016;23:2788)
  • Frozen section of lumpectomy margins offers potential cost saving to patients and payers (Oncol Pract 2016;12:e413)
  • Frozen section assessment of nipple margins for nipple sparing mastectomy is highly specific but only moderately sensitive for the detection of carcinoma in subareolar tissue, allowing nipple resection at the time of mastectomy (Breast J 2016;22:18)
Gross images

Images hosted on other servers:

Tumor with positive margins

Microscopic (histologic) description
  • Diagnostic errors in frozen section of breast tissue include sampling errors or proliferative lesions mimicking in situ (usual ductal hyperplasia, papilloma) and invasive carcinoma (sclerosing adenosis) (Tumori 1999;85:15)
Microscopic (histologic) images

Images hosted on Pathout server:

Images contributed by Emily S. Reisenbichler, M.D.
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Dermal lymphovascular invasion

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Invasive lobular carcinoma

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Invasive mammary carcinoma


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Nipple with chronic inflammation

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Sclerosing adenosis

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Ductal carcinoma in situ



Images hosted on other servers:

Infiltrating ductal carcinoma

Differential diagnosis
Additional references
Board review question #1
    Which of the following is not currently a typical use of intraoperative frozen section in breast cancer surgical management?

  1. Axillary sentinel lymph node evaluation.
  2. Breast margin evaluation in breast conserving surgery.
  3. Nipple margin evaluation in nipple sparing mastectomy.
  4. Primary diagnosis of a breast mass for same day surgical management.
Board review answer #1
D. Primary diagnosis of a breast mass for same day surgical management.

In the past, breast carcinoma could be diagnosed intraoperatively, allowing surgical management to take place at the time of the primary biopsy. In the current age of neoadjuvant therapy, testing breast carcinomas for estrogen / progesterone receptor and HER2 status prior to definitive surgical management is the standard of care.