Intraoperative frozen section assessment in the evaluation of axillary sentinel lymph node in breast cancer

Abstract

Introduction:Intraoperative frozen section analysis has become a routine procedure to evaluate the status of axillary sentinel lymph nodes in breast cancer. Objectives: To evaluate the accuracy and sensitivity of FS in the detection of metastases in axillary sentinel lymph nodes and to investigate the predictive value of variables such as patients' age, tumor staging, histology, grade, and estrogen receptor expression. Material and Methods: We analyzed retrospectively the results of 177 FS procedures. The patients' age and tumor characteristics were organized in a database and the association with the presence of metastases was analyzed. Results: Metastases were detected in 22 cases (12%). All macrometastases and one micrometastasis were detected by FS. Additional micrometastases were detected in post-operative analysis, from which five were determined by hematoxylin and eosin staining (H&E) and three by immunohistochemistry (IHC). FS diagnosis data proved to have an overall accuracy of 95%, sensitivity of 64%, and specificity of 100%. None of the analyzed variables showed significant association with lymph node metastases. Conclusion: Our results show that intraoperative FS is a highly accurate and sensitive method to detect macrometastases. However, it is inaccurate in the detection of micrometastases.

A histochemical study to identify nodal micro-metastasis in oral squamous cell carcinoma

“…18 Thakare et al 5 in their study observed micro-metastatic carcinomatous cells in H and E staining of frozen section (FS) in 18 lymph nodes (54%) and in 19 lymph nodes (57%) in step-serial sectioned (SS) H and E-stained sections. 5 Thome JA et al 19 results showed that intra-operative FS is a highly accurate and sensitive method to detect macro-metastasis. However, it is inaccurate in the detection of micro-metastasis.…”

“…However, it is inaccurate in the detection of micro-metastasis. 19 In the view of crucial role of occult LN metastasis in prognosis and survival of OSCC patients with N0 neck Dhawan et al 9 recommended diagnostic tools such as IHC staining, particularly with pan-CK (AE1/ AE3), combined with SS should be preferred over conventional methods as they result in upstaging, thus sparing the low-risk patients the morbidity of unnecessary treatment. 9 Histopathological analysis of neck dissection specimens is usually performed on several 3-4-μm sections from each lymph node; micrometastasis can be easily missed on routine light microscopy.…”

A Acurácia Diagnóstica Das Patologias Cirúrgicas Nos Exames Por Congelação.

“…O presente estudo avaliou um total de 697 exames por congelação realizados em um período de cinco anos no serviço de anatomia patológica de um hospital universitário, o que se trata de uma amostra expressiva, pois supera o número de exames que embasaram trabalhos anteriores 2,5,6,7 , além de conseguir abarcar diversos órgãos e tecidos, diferentemente de estudos que, por exemplo, se detiveram a determinados sítios anatômicos específicos como pele 8 e linfonodo 9 .…”

“…2 observou que há uma dificuldade aumentada na detecção de microcarcinomas papilíferos, o que impacta negativamente nos diagnósticos por congelação. Em relação aos linfonodos, esta técnica é altamente sensível na detecção de macrometástases, no entanto, não consegue identificar micrometástases, cuja determinação é melhorada pela adição da imuno-histoquímica à análise pós-operatória 9 .…”