PRE‐OPERATIVE HISTOLOGICAL DIAGNOSIS OF BREAST CANCER

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Abstract
Background: A concordant triple assessment (clinical, mammographic and cytological) diagnosis of breast malignancy allows for pre‐operative planning of surgery and may also allow for one‐stage surgery. However, while the accuracy of cytology is high, it is unable to distinguish invasive cancer from ductal carcinoma in situ (DCIS). A malignant mass may be due to pure in situ cancer and hence axillary dissection may be avoided if pre‐operative histology is available. Methods: A consecutive series of 300 cases of breast cancer treated over the last 5 years by the two authors was analysed to determine: the method of achieving pre‐definitive operation histology; the number of stages of surgery required; and the number of cases of mass‐forming DCIS which could be susceptible to over‐treatment. Results: Of 289 patients undergoing local definitive surgery for breast cancer, 12 (42%) had clinical masses predominantly due to DCIS and in most of these patients axillary dissection was avoided. Histology was obtained prior to definitive surgery in 272 (94.1%) patients, by intra‐operative frozen section in 159 (55.0%), incisional biopsy in 37 (12.8%), needle localization biopsy in 62 (21.5%) and core biopsy in 14 (4.8%). A total of 189 patients (65.4%) underwent one‐stage surgery only. Breast conservation was achieved in 210 (72.7%) patients. Those requiring mastectomy were significantly more likely to have required two stages of surgery as were those with lesions detected by screening. Conclusions: Mass‐forming DCIS cannot be predicted pre‐operatively by triple assessment alone; and therefore pre‐operative histology is required to avoid axillary dissection. Pre‐operative histology may be obtained by core biopsy or intra‐operative frozen section to identify DCIS and distinguish it from invasive disease, but both allow a one‐stage surgical procedure in the majority of cases.