Can intraoperative ultrasound replace the frozen section in the assessment of ex vivo sentinel lymph node biopsy in early breast cancer in countries with limited resources?

Rasha Wessam Abdel Rahman,Somia Abdulatif Mahmoud Soliman,Mohannad Aly Fayed,Mohamed Nasr Hafez,Emad Salaheldin Khallaf,Lamia Adel Salaheldin

doi:10.1186/s43055-021-00505-1

Rasha Wessam Abdel Rahman, Somia Abdulatif Mahmoud Soliman + Show 4 more

Open Access

https://doi.org/10.1186/s43055-021-00505-1

Copy DOI

Abstract

BackgroundAccurate staging and proper management of axillary lymph nodes (ALNs) in breast cancer patients are important for treatment. Surgical management of the axilla has evolved greatly in the last 20 years. Sentinel lymph node biopsy (SLNB), which was first investigated in the early 1990s, has replaced routine axillary lymph node dissection. This study evaluates the capability of using an ultrasound (US) as an alternative tool for the frozen section in the assessment of the ex vivo sentinel lymph node biopsy in countries with limited resources.ResultsThe study is a prospective study that included 216 female patients with early breast cancer and negative axillary lymph nodes. All excised lymph nodes were examined by the intraoperative US and frozen section examinations. All the results were correlated with the final histopathological results. The number of negative nodes by US, frozen, and paraffin section examination was 58.30%, 69.40%, and 69.40%, respectively. The number of positive nodes by the US, frozen, and paraffin section examinations was 41.70%, 30.60%, and 30.60% respectively. The sensitivity, specificity, PPV, NPV, and accuracy of US in the detection of positive lymph nodes were 95.45%, 82%, 70%, 97.62%, and 86.11%, respectively, and the sensitivity, specificity, PPV, NPV, and accuracy of frozen examination in the detection of positive lymph nodes were 90.91%, 96%, 90.91%, 96%, and 94.44%, respectively.ConclusionIntraoperative US is a good negative test in the assessment of ex vivo SLNB, but it is not a good positive test, so it cannot replace the intraoperative frozen section in the assessment of SLNs.

Highlights

Accurate staging and proper management of axillary lymph nodes (ALNs) in breast cancer patients are important for treatment
Sentinel lymph node biopsy (SLNB) is a minimally invasive technique for assessing the axilla; it had been used as an alternative to axillary lymph node dissection (ALND) and has become care management for clinically node-negative cancer patients as it is significantly reduced surgical morbidity [2]
Two hundred and sixteen early breast cancer female patients T1-2, N0 M0 were a candidate for SLNB; their SLN specimens were examined intraoperatively by ultrasound

Summary

Introduction

Accurate staging and proper management of axillary lymph nodes (ALNs) in breast cancer patients are important for treatment. This study evaluates the capability of using an ultrasound (US) as an alternative tool for the frozen section in the assessment of the ex vivo sentinel lymph node biopsy in countries with limited resources. Axillary lymph node (LN) metastasis is an important factor in the prognosis of breast cancer because of their impact on further patient management and overall survival. Sentinel lymph node biopsy (SLNB) is a minimally invasive technique for assessing the axilla; it had been used as an alternative to axillary lymph node dissection (ALND) and has become care management for clinically node-negative cancer patients as it is significantly reduced surgical morbidity [2]. Immediate ALND with avoidance of second surgery for patients with tumor-positive axillary lymph nodes can be performed if intraoperative frozen pathological examination of SLN has been performed intraoperatively. Most patients in that trial had favorable clinical-pathological factors, the routine use of frozen section for the evaluation of SLNB is questionable [4]

Methods

Results

Discussion

Conclusion