Is intra-operative nodal assessment essential in a modern breast practice?

Sentinel Node Biopsy in Early Breast Cancer: Lessons Learned from More than 1000 Cases at a Single Institution

“…From the first case onwards, we carried out intraoperative frozen sections for sentinel node assessment. Whether or not to perform intraoperative sentinel node examination is still a matter of debate 20 . One argument in its favor is that it allows immediate ALND in patients with a positive sentinel node, thus avoiding a second operation.…”

“…The relatively low discordance rate between frozen section and final histology observed in our series is likely a reflection of both multidisciplinary expertise in SNB and pathologists' skills in conducting and interpreting the results of sentinel node frozen sections. In many European and US breast units, intraoperative assessment of the sentinel node is not performed and preoperative SNB under local anesthesia is preferred 20,21 . We believe that both methods are valid.…”

Diagnosis and Local Management of Breast Cancer: Part I

“…Nonetheless, there are lingering concerns regarding potential false positivity, and even the fundamental need for intraoperative node assessment has been questioned in a recent editorial by Benson and Wishart, which formed the basis for a conference presentation [1]. Following this, a significant proportion of delegates (almost a third) conceded that intraoperative nodal assessment may not be essential in a modern breast practice that incorporates sentinel lymph node (SLN) biopsy prior to both immediate breast reconstruction and primary chemotherapy (PC), preoperative axillary ultrasound (with or without nodal biopsy) and selective omission of completion axillary lymph node dissection (cALND) in SLN biopsy-positive cases.…”

“…These factors collectively reduce the absolute numbers of isolated cALNDs, particularly when up to half of patients have cALND performed alongside definitive or additional breast surgery. Intraoperative node assessment may further reduce these low recall rates for isolated cALND (~10%), but may not be cost-effective nor logistically feasible within many healthcare systems [2].…”