A study of the presence of unexpected granulomatous disease in lymph nodes excised during surgery for suspected or known breast cancer

Abstract

Background: Surgery is first line treatment for most breast cancers, with many patients having axillary lymph node sampling or excision to rule out cancer spread. NICE guidance states that all excised lymph nodes should be analysed by microbiology to rule out TB. We investigated whether lymph nodes excised during surgery for known or suspected breast cancer had been tested for TB, and if this was something that should be done routinely, based on the presence of unexpected granulomas on histopathology in these patients. Methods: The electronic medical records of 133 patients who had breast surgery with lymph node removal or sampling at Princess Royal Hospital in Telford from 01/09/2015 to 01/12/2015 were examined retrospectively. Information was gained on the surgery undertaken, if cancer had been proven in patients prior to surgery, if granulomata were reported to be present in the histology, and if the samples were tested for TB. Results: 133 patients had lymph node excision by the breast surgeons during the 3 month period. 130 patients had known breast cancer and 3 had diagnostic lymph node biopsy. None of the lymph nodes were reported as showing granulomatous disease and none had microbiological tests for TB. There was no difference between patients with known or suspected cancer. Conclusions: Our sample shows that granulomatous disease is very rare in lymph nodes excised by breast surgeons in the context of breast cancer. The absence of granulomatous disease in this group suggests that guidance to send routine TB cultures on all lymph nodes excised may have to be revised to include the existing background clinical problem as a guiding factor.