Abstract
Objective: Nodal status is still the most important independent prognostic factor in breast cancer. In this study, we aimed to investigate the effect of lymph node revealing solution (LNRS) on the number and diameter of removed lymph nodes and nodal staging.
 Study Design: Consecutive 150 patients, diagnosed breast carcinoma, were included in the study. After excising the lymph nodes by the traditional method, remaining axillary tissue was immersed in LNRS for 6-12 hours. lymph nodes, which stood out as white chalky nodules, were excised and processed as usual.
 Results: An increase of 5.80 (32.03%) in the number of lymph nodes per case was observed, which was statistically significant. The diameters of the lymph nodes removed with LNRS were smaller compared to the classical method, and this was statistically significant as well. Furthermore, the LINES changed nodal stage of the disease in five of the studied cases.
 Conclusions: LNRS increases the number of lymph nodes that are removed and detects smaller lymph nodes. It may be an alternative method in cases with removed lymph nodes are critical number or under. Thus, accurate nodal staging and prognostic information will be obtained by using LNRS and more accurate treatment management will be provided.
Highlights
We aimed to investigate the effect of fixation of remaining axillary tissue with lymph node revealing solution (LNRS) on the number of removed lymph nodes and diameter and, the effect on nodal staging
It was observed that LNRS fixation resulted in the observation of firmer lymph nodes with a white chalk-like color on their cut surfaces compared with that observed using the formalin solution method (Fig. 1B)
A 1-mm diameter lymph node that could not be detected in the axillary material using the classical method was identified using the LNRS method (Fig. 1C)
Summary
Histological type, histological grade, hormone receptors, and human epidermal growth factor receptor 2 positivity are important parameters that determine the prognosis of patients with breast cancer [2,3,4]. Except for haematogenous dissemination observed in a small portion of breast cancer, the axillary lymph nodes are the first metastatic site and the nodal status is still the most important independent prognostic factor [5, 6]. Breast carcinoma staging (pTNM) is made by considering tumor size and spread, nodal status and distant metastasis. Nodal staging is based on both the number of metastatic lymph nodes and the metastasis diameter [7]. Only patients with 1-3 node-positive cases have better prognosis compared to those with 4 or higher node-positive patients [8, 9]
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