Breast cancer micrometastasis and axillary sentinel lymph nodes frozen section. Our experience and review of literature

Sanguinetti, Alessandro; Polistena, Andrea; Lucchini, Roberta; Monacelli, Massimo; Triola, Roberta; Avenia, Stefano; Barillaro, Ivan; Patrizi, Micol Sole Di; Boccolini, Andrea; Conti, Claudia; Bistoni, Giovanni; Avenia, Nicola

doi:10.1016/j.ijsu.2014.05.044

Cited by 12 publications

(9 citation statements)

References 26 publications

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“…This is reflected in our study by the fact that most of the patients who didn't receive further axillary clearance for micrometastasis were the more recent patients in the study. The number of patients in the study could be a limitation too, but is comparable to other retrospective studies who tried to address the topic [14] [15] [16]. The median follow-up period of the study is also short.…”

Section: Discussionmentioning

confidence: 66%

The significance of sentinel lymph node micrometastasis in breast cancer: Comparing outcomes with and without axillary clearance

et al. 2016

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Section: Discussionmentioning

confidence: 66%

The significance of sentinel lymph node micrometastasis in breast cancer: Comparing outcomes with and without axillary clearance

et al. 2016

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“…The relationship of ITCs and discordance has been described in the literature on intraoperative SLN assessment. 7 -10,13 -18 In the non-NAT patients, we found higher number of cases with ITCs present than in the NAT patients, and this affected the overall sensitivity and accuracy. The lower number of cases with ITCs present in NAT patients may represent the effectiveness of systemic therapy in eliminating ITCs.…”

Section: Discussionmentioning

confidence: 82%

“…12 The American Society of Clinical Oncology recently recommended SLN biopsy for NAT patients based on the benefits of avoidance of ALND morbidity and the potential of lymph node downstage following NAT; however, guidelines in the literature on intraoperative assessment of BC in the NAT setting are not well established. 12 For non-NAT patients, recent studies have demonstrated that FNR for intraoperative assessment of SLN vary from 13% to 22.6%, [13][14][15][16][17] including cases with ITCs. Meanwhile for NAT patients, approximately 50% of patients have residual nodal disease after NAT, 18 and FNR for intraoperative assessment vary from 20% to 26.1%, [7][8][9][10] including cases with ITCs.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Assessment of Sentinel Lymph Nodes in Breast Cancer Patients Post-Neoadjuvant Therapy

Wong

Rubenchik

Nofech‐Mozes

et al. 2019

Technol Cancer Res Treat

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Background:Shift toward minimizing axillary lymph node dissection in patients with breast cancer post neoadjuvant therapy has led to the assessment of sentinel lymph nodes by frozen section intraoperatively to determine the need for axillary lymph node dissection. However, few studies have examined the accuracy of sentinel lymph node frozen section after neoadjuvant therapy. Our objective is to compare the accuracy of sentinel lymph node frozen section in patients with breast cancer with and without neoadjuvant therapy and to identify features that may influence accuracy.Design:We identified 161 sentinel lymph node frozen section from 77 neoadjuvant therapy patients and 255 sentinel lymph node frozen section from 88 non-neoadjuvant therapy patients diagnosed between 2010 and 2016 in 2 institutions. The frozen section diagnoses were compared to the final diagnoses, and clinicopathologic data were analyzed.Results:The sensitivity, specificity, and accuracy of frozen section analysis were comparable between neoadjuvant therapy patients and non-neoadjuvant therapy patients (71.9% vs 50%, 100% vs 100%, and 88.3% vs 81.8%). Nine (11.7%) of 77 neoadjuvant therapy patients had discordant results, most often due to undersampling (tumor absent on frozen section slide). Four of these patients subsequently underwent axillary lymph node dissection. Discordant results (all false negatives) were significantly more likely in neoadjuvant therapy patients with Estrogen Receptor-positive/HER2-negative status, and in sentinel lymph node with pN1mic and pN0i+ deposits; age, preneoadjuvant therapy lymph node status, histotype, nuclear grade, tumor size, and response to neoadjuvant therapy showed no significant differences. For non-neoadjuvant therapy cases, large tumor size, lobular histotype, and sentinel lymph node with pN1mic and pN0i+ were associated with false-negative frozen section assessment.Conclusion:Sentinel lymph node frozen section diagnosis post-neoadjuvant therapy has comparable sensitivity, specificity, and accuracy to the sentinel lymph node frozen section diagnosis in the non-neoadjuvant therapy setting.

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“…Serial sectioning invariably increases the sensitivity of touch preparation or frozen section over simply examining the cut sides of the bisected node 12 . In addition, the rate of nodal positivity in published series is dependent on whether immunohistochemistry (IHC) is used or not 13–15 . That being said it is clear from the published series that whatever method is used to evaluate the sentinel node during surgery, more comprehensive examination of the lymph nodes results in a higher yield of identified metastasis 16 …”

Section: Discussionmentioning

confidence: 99%

Quality assurance review: Intra‐operative evaluation of sentinel lymph nodes in breast cancer

Aldoheyan

Klein

2021

Cancer Medicine

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Background Intraoperative consultation (IOC) of axillary sentinel lymph node (SLN) biopsy continues to play a role in selected breast cancer patients. The reported sensitivity rates for intraoperative SLN evaluation in breast cancer range from 47% to 80%. We study a center where the majority of SLN IOC is performed by imprint cytology, and a protocol was established to limit microscopic examination to three slides for a reporting TAT goal of 30 min. Methods Approval to conduct this study was obtained from the REB. A retrospective review was performed on all consecutive SLN cases sent for IOC. Reported IOC assessments of all cases were compared with the final pathology. Results Of 164 patients, there were 22 (13%) false negative IOC events, including 15 missed macro‐metastasis and 7 missed micro‐metastasis. The overall sensitivity for touch imprint in detecting SLNs macro‐metastasis was 70.9%. Reporting total turnaround time was on average 3 min longer, whereas sensitivity and specificity were not significantly different in the two protocol periods. Conclusion Implementation of an IOC policy for a maximum of three slides for imprint cytology did not result in a significant impact on the sensitivity, specificity, or total turnaround time for SLN in breast cancer patients. False negative IOC events were mainly due to sampling error. Quality review was made difficult by limited documentation related to the gross handling of the specimens at IOC. System factors identified include insufficient space for the IOC report on the pathology requisition, and the lack of clearly communicated expectations for documentation.

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Breast cancer micrometastasis and axillary sentinel lymph nodes frozen section. Our experience and review of literature

Abstract: Analysis of frozen section of SLNs is an accurate method for metastasis detection, allowing concurrent axillary dissection when positive. The protocol for SLN analyses described herein shows good sensitivity for micrometastasis detection.

Cited by 12 publications

References 26 publications

The significance of sentinel lymph node micrometastasis in breast cancer: Comparing outcomes with and without axillary clearance

The significance of sentinel lymph node micrometastasis in breast cancer: Comparing outcomes with and without axillary clearance

Intraoperative Assessment of Sentinel Lymph Nodes in Breast Cancer Patients Post-Neoadjuvant Therapy

Quality assurance review: Intra‐operative evaluation of sentinel lymph nodes in breast cancer

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