Recommendations for Sentinel Lymph Node Processing in Breast Cancer

Abstract

The status of the sentinel lymph node (SLN) has been shown to accurately reflect the presence or absence of metastases in the axilla in patients with breast cancer. This study was designed to determine the optimal protocol for SLN processing. A total of 173 SLNs from 96 breast cancer patients who had successful SLN localization and underwent completion axillary node dissection were identified. All SLNs were negative for metastases by initial routine histologic evaluation. The nodes were submitted in a total of 300 blocks. Each block was serially sectioned to produce 10 levels. Pan-cytokeratin stain was performed on levels 3 and 8. All other levels were stained with hematoxylin and eosin. Metastases were identified in 22 SLNs from 19 patients by examining all 10 levels. The first two hematoxylin and eosin- or the first cytokeratin-stained levels were positive for metastases in 21 (95.5%) of the 22 positive SLNs. Two additional hematoxylin and eosin-stained and one cytokeratin-stained levels of each SLN correctly identified the status of the node in 94 (97.9%) of 96 patients. Therefore, we recommend that after an initial hematoxylin and eosin-stained section, two additional hematoxylin and eosin-stained sections and one cytokeratin-stained section should be evaluated.

Sentinel node staging for breast cancer: intraoperative molecular pathology overcomes conventional histologic sampling errors

“…Permanent section histologic evaluations are reported to miss at least 10% to 15% of metastases >.2 mm because of practical limitations in sampling [7] and [12]. The same sampling errors necessarily contribute to the lack of perfect agreement between the BLN Assay and the OHR.…”

The value of immunohistochemistry in sentinel lymph node histopathology in breast cancer

“…It has been demonstrated that the majority of metastases will be detected in the first few sections examined (Cserni, 2002;Yared et al, 2002). Yared et al (2002) examined 10 levels of serially sectioned SLNs and performed IHC on levels 3 and 8, while the remaining levels were stained with H&E. The authors found that the first two H&E or the first cytokeratin-stained levels were positive for metastases in 96%.…”

“…Yared et al (2002) examined 10 levels of serially sectioned SLNs and performed IHC on levels 3 and 8, while the remaining levels were stained with H&E. The authors found that the first two H&E or the first cytokeratin-stained levels were positive for metastases in 96%. Two additional H&E-stained and one cytokeratin-stained level of each SLN correctly identified the status of the node in 98% of cases.…”

Detection of Lymphatic Micrometastases in Patients With Stages I and II Colorectal Cancer: Impact on Five-Year Survival

“…17,18 Two of these sections were stained with H & E for the verification of the standard histopathologic results (e.g., the first and third), and the others (e.g., Numbers 2 and 4) were stained by immunohistochemistry. Immunohistochemical staining was performed with antipancytokeratin antibodies (primary murine polyclonal anti-human-keratins antibodies, clones AE1, AE3, and PCK2, dilution 1:100) following the standard procedure established for an automatized system (Nexes ® , Tucson, AZ).…”