Abstract
BackgroundMaximisation of the potential of sentinel lymph node biopsy as a minimally invasive method of axillary staging requires sensitive intraoperative pathological analysis so that rates of re-operation for lymphatic metastases are minimised. The aim of this study was to describe the test parameters of the frozen section evaluation of sentinel node biopsy for breast cancer compared to the gold standard of standard permanent pathological evaluation at our institution.MethodsThe accuracy of intraoperative frozen section (FS) of sentinel nodes was determined in 94 consecutive women undergoing surgery for clinically node negative, invasive breast cancer (37:T1 disease; 43:T2; 14:T3). Definitive evidence of lymphatic spread on FS indicated immediate level II axillary clearance while sentinel node "negativity" on intraoperative testing led to the operation being curtailed to allow formal H&E analysis of the remaining sentinel nodal tissue.ResultsIntraoperative FS correctly predicted axillary involvement in 23/30 patients with lymphatic metastases (76% sensitivity rate) permitting definitive surgery to be completed at the index operation in 87 women (93%) overall. All SN found involved on FS were confirmed as harbouring tumour cells on subsequent formal specimen examination (100% specificity and positive predictive value) with 16 patients having additional non-sentinel nodes found also to contain tumour. Negative Predictive Values were highest in women with T1 tumours (97%) and lessened with more local advancement of disease (T2 rates: 86%; T3: 75%). Of those with falsely negative FS, three had only micrometastatic disease.ConclusionIntraoperative FS reliably evaluates the status of the sentinel node allowing most women complete their surgery in a single stage. Thus SN can be offered with increased confidence to those less likely to have negative axillae hence expanding the population of potential beneficiaries.
Highlights
Maximisation of the potential of sentinel lymph node biopsy as a minimally invasive method of axillary staging requires sensitive intraoperative pathological analysis so that rates of reoperation for lymphatic metastases are minimised
As axillary clearance remains the standard of care for those with nodal spread[1], many centres confine the use of Sentinel lymph node (SLN) mapping to women with "early" or "small" breast cancer (i.e. T1 cancers in most instances)[2]
We describe our experience of routine intraoperative frozen section of sentinel nodes in women with invasive breast cancer but without overt lymphatic metastases in order to contribute to the emerging body of data regarding its practical reliability and clinical utility
Summary
Maximisation of the potential of sentinel lymph node biopsy as a minimally invasive method of axillary staging requires sensitive intraoperative pathological analysis so that rates of reoperation for lymphatic metastases are minimised. As axillary clearance remains the standard of care for those with nodal spread[1], many centres confine the use of SLN mapping to women with "early" or "small" breast cancer (i.e. T1 cancers in most instances)[2]. Such a strategy deprives the benefits of minimally invasive lymphatic staging from those women who have disease that is locally advanced but still contained within the breast. We describe our experience of routine intraoperative frozen section of sentinel nodes in women with invasive breast cancer but without overt lymphatic metastases in order to contribute to the emerging body of data regarding its practical reliability and clinical utility
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