Axillary Staging In Breast Cancer Research Articles

When is a Lymph Node Dissection a Lymph Node Dissection? The Number of Lymph Nodes Resected in Sentinel and Axillary Lymph Node Dissections

We sought to compare the number of lymph nodes (LN) resected in axillary lymph node dissections (ALND) and sentinel lymph node dissections (SLND), and to assess the validity of registry reporting for axillary staging in breast cancer. Women in the California Cancer Registry who underwent surgical axillary staging for T1/T2, M0 breast cancer between 2004 and 2008 were evaluated. The number of LN resected in patients reported as having SLND+ALND and ALND were assessed for compliance with 6 and 10 LN threshold definitions for ALND. The proportion of patients with ≤3 LN removed was assessed for patients receiving SLND only. Of 71,907 patients, 45.5 % had SLND, 24.0 %, SLND+ALND, and 30.5 %, ALND. The median number of LN resected with SLND cases was 2 (range 1-41); SLND+ALND, 9 (range 1-63); and ALND, 11 (range 1-81) (p < 0.0001). Of patients undergoing ALND, 56.7 % had ≥10 LN removed; 46.2 % of patients with SLND+ALND had ≥10 LN removed (p < 0.0001). Overall, 75.5 % of patients with ALND had ≥6 LN removed and 67.8 % of patients with SLND+ALND had ≥6 LN removed (p < 0.0001). Of those receiving only SLND, 83.4 % had ≤3 LN removed. A significant proportion of patients did not meet the minimum LN count thresholds for full ALND or had excess LN removed in a SLND. Further investigation is required to determine whether absolute LN number or reported operative procedure and implied surgical technique better defines axillary staging in a registry database.

Clinical and histopathological factors affecting failed sentinel node localization in axillary staging for breast cancer

BackgroundSentinel lymph node biopsy (SLNB) has become the standard of care in axillary staging of clinically node-negative breast cancer patients. AimsTo analyze reasons for failure of SLN localization by means of a multivariate analysis of clinical and histopathological factors. MethodsWe performed a review of 164 consecutive breast cancer patients who underwent SLNB. A superficial injection technique was used. Results9/164 patients failed to show nodes. In 7/9 patients no evidence of radioactivity or blue dye was observed. Age and nodal status were the only statistically significant factors (p < 0.05). For every unit increase in age there was a 9% reduced chance of failed SLN localization. Patients with negative nodal status have 90% reduced risk of failed sentinel node localization than patients with macro or extra capsular nodal invasion. DiscussionThe results suggest that altered lymphatic dynamics secondary to tumour burden may play a role in failed sentinel node localization. We showed that in all failed localizations the radiocolloid persisted around the injection site, showing limited local diffusion only. While clinical and histopathological data may provide some clues as to why sentinel node localization fails, we further hypothesize that integrity of peri-areolar lymphatics is important for successful localization.

Correlation of number and identification of sentinel nodes during radiographer led lymphoscintigraphy prior to sentinel lymph node biopsy in breast cancer patients

Purpose The sentinel lymph node biopsy (SLNB) concept using the cutaneous (subdermal) peri-areolar approach is rapidly emerging as the technique for axillary staging in breast cancer. The procedure indicates whether axillary lymph node dissection (ALND) is necessary, therefore drastically minimising the invasiveness of surgical treatment. The SLNB concept is based on evidence suggesting that malignant disease primarily affects the sentinel node (SN) before being disseminated into the axillary lymph nodes (ALNs). Objective This study was to define the role of lymphoscintigraphy in the visualisation of SNs during SLNB and to establish the correlation between the number of SNs identified on lymphoscintigraphy to the number of surgically identified SNs. Method The study was a non-experimental, correlation study utilising quantitative data. Lymphoscintigraphy reports and histology results of 55 female breast cancer patients who underwent SLNB with partial or total back-up ALND, were retrospectively evaluated. Results A maximum of 2 and a minimum of 0 sentinel nodes were visualised on lymphoscintigraphy in 52 out of 55 patients. Successful lymphoscintigraphy was highly predictive ( p ≤ 0.001) of a successful SLNB as all 52 patients (94.5%) proceeded to have successful SN/s identification. There was a significant association ( p ≤ 0.05) between the number of SN/s visualised on lymphoscintigraphy and the number of SN/s identified during SLNB. Lymphoscintigraphy accurately predicted the number of surgically identified SNs in 50.91% of cases (28/55). Conclusion Considering that successful imaging effectively assures SN identification, the routine use of lymphoscintigraphy using the subdermal peri-areolar approach is fundamental in the reliable performance of SLNB.

Preoperative sonographic axillary staging in breast cancer: correlation with sentinel node sampling

Axillary ultrasound staging with core biopsy (CB) or fine needle aspiration (FNA) in primary breast cancer is well established. Negative patients will have a sentinel lymph node biopsy (SLNB). This study compares the initial ultrasound finding versus final axillary histology in patients undergoing SLNB.

Audit of accuracy of ultrasound-guided axillary core biopsy

Sentinel lymph node biopsy (SLNB) is the preferred method of axillary staging in breast cancer. If metastases are detected, axillary node clearance (ANC) is necessary. Preoperative detection of nodal metastases using ultrasound-guided core biopsy (USCB) allows the surgeon to proceed directly to ANC. Negative CBs do not exclude metastases. All patients still need SLNB. However, by minimising false negatives, unnecessary SLNBs can be minimised. We compared our USCB results with the results of subsequent SLNB + axillary node sampling (ANS) or ANC to assess our accuracy.

Pre-operative Ultrasound Staging of the Axilla in Breast Cancer - Repeat Audit Cycle

Introduction: Axillary ultrasound (AUS) for axillary staging of breast cancer is a standard procedure now to identify metastatic lymph nodes (LN). In 2009 we retrospectively audited AUS for axillary staging and found a sensitivity of 57.7% and specificity of 92.7% in our breast unit. However, only 50% of abnormal nodes were AUS-guided biopsied. In this study we aim to close the audit cycle by assessing whether the prevalence of AUS has increased and more abnormal nodes have been biopsied.

Predictions for positive nodes in breast cancer using computerized modeling.

16 Background: The accuracy and consistency of sentinel lymph node (SLN) biopsy for axillary staging in breast cancer has been well established by multiple studies. Although the standard of care has been to perform a completion axillary lymph node dissection (ALND) on patients who have a positive sentinel node, recent data (ACOSG Z0010, Z0011 and NSABP B-32) suggests that an ALND may be avoided in certain subsets of patients. To further study this question, we used a Bayesian model to predict the probability of finding disease in the ALND for breast cancer. Methods: All SLN procedures performed by a single surgeon, for clinical T1-T2 N0 disease between September 2000 and March 2009 were retrospectively reviewed under an IRB approved protocol. Demographic, disease and surgical procedural variables were collected. Values are reported as mean ± standard deviation. A Bayesian model, a standard statistical model frequently used in medicine, was used to identify variables that could predict a positive ALND. Results: A total number of 235 SLN procedures were reviewed. The mean patient age was 58.6 ± 11.8 (range 28-88), tumor size was 1.8 ± 1.3 cm (range 0.2-7.4), and BMI was 28 ± 6.1. The number of SLN found was 3.6 ± 1.9 (range 0-10), and in 2 cases no SLN were found, for an overall failure rate of 0.85%. A total of 73 ALND were performed in this group; 27 cases had ALND as national study participants randomized to ALND, 44 cases for positive SLN, and 2 cases in which no SLN could be identified. The mean number of axillary lymph nodes removed was 14.8 ± 7 and the mean number of positive axillary nodes was 2.7 ± 4.1. Tumor size, tumor grade, number of positive SLN by hematoxylin and eosin staining, and a low technetium count of the first SLN were found to be significant predictors of positive axillary nodes during a completion ALND. There was also a trend for progesterone receptor expression as a predictor of axillary disease. Conclusions: A model to predict a positive ALND for breast cancer is presented. We found tumor characteristics, number of positive SLN and low technetium count for first SLN to be predictors for finding axillary disease. Further studies are needed to validate our model as a means of sparing women an ALND who have a low probability of finding additional breast disease.

Détection du ganglion sentinelle chez les patientes atteintes d’un cancer du sein à un stade précoce : quel site d’injection en 2011 ?

Sentinel lymph node (SLN) mapping and biopsy have emerged as the technique of choice for axillary staging of breast cancer. Several methods have been developed to identify SLNs, including peritumoral or periareolar injection of blue dye or technetium colloid. The optimal site for injection of mapping tracers is controversial in SLN. The peritumoral injection provides information on the deep lymphatic drainage and the internal mammary chain. The advantages of periareolar injection are simplicity, the ability to perform it in non-palpable tumors, and the potential enhancement of uptake via the subareolar lymphatic plexus. The results of multiinstitutional study have indicated that superficial injection (periareolar or peritumoral) is associated with a better identification rate and an equal false-negative rate compared to deep peritumoral (PT) injection. However, the false-negative rate of periareolar injection has not been formally demonstrated.

Sentinel Lymph Node Detection in a Patient with Subungual Melanoma after Transaxillary Breast Augmentation

Sir: Transaxillary breast augmentation is performed worldwide. It is associated with pleasant aesthetic results and the possibility of hiding and minimizing the scar out of the breast.1,2 However, there is great concern regarding possible injuries to lymphatic structures in the axilla and future oncologic consequences related to this. The sentinel lymph node investigation is a well-established method of axillary staging in breast cancer and upper limb melanoma. The possibility of alteration in the breast lymphatic drainage caused by axillary surgical access could interfere with sentinel lymph node mapping if the patient develops a future breast cancer or upper limb melanoma.1–3 A 45-year-old, white, previously healthy woman was submitted to transaxillary breast augmentation and evaluation of axillary lymphatic vessels and sentinel node mapping during research developed in our department.1,2 The incision was S-shaped, 4 cm long, in the main axillary fold, and 1 cm posterior to the lateral border of the major pectoralis muscle. A subcutaneous tunnel was dissected up to the superolateral border of the muscle, preserving an inferolateral triangle of soft tissue containing most of the lymphatic vessels (Fig. 1, left). The mammary implant was placed in a subfascial pocket and 0.5 ml of blue dye was injected subdermally at a point superior and lateral to the areola in both breasts (Fig. 1, right). After 1 minute of gentle pressure over the injected point, blue dye was seen in the lymphatic vessels of the soft-tissue triangle preserved lateral and inferior to the lateral border of the major pectoralis muscle. There was no diffusion of blue dye into surrounding tissues, suggesting no major injury of lymphatic structures in the axilla.Fig. 1.: Preoperative axillary markings showing the subcutaneous pathway to be dissected with preservation of the “soft-tissue triangle” (left). Identification of lymphatic structures in the axilla after periareolar blue dye injection (right).Two years later, the patient developed a subungual melanoma in the right thumb and was submitted to amputation of the distal phalanx plus investigation of sentinel node in the axilla (Fig. 2).Fig. 2.: Transaxillary breast augmentation (left) following amputation of the right thumb phalange (right); a diagnosis of subungual melanoma was made.The sentinel lymph node was identified successfully in the axilla with the technique of blue dye injection plus lymphoscintigraphic investigation. It was negative for malignancy and free of micrometastasis. The patient is free of the disease until the present. Concerning possible injuries to lymphatic structures during the transaxillary approach for breast augmentation, Prado et al.4 suggested that this surgical access could eventually traumatize the lymph nodes of the armpit in a perimeter of 5 to 6 cm, where the sentinel node is usually located.5 In recent lymphoscintigraphic study, Graf et al.1 and Sado et al.2 showed that although partial and transitory impairment of lymphatic drainage can occur shortly after transaxillary breast augmentation, it does not interfere with lymphatic drainage and location of the sentinel node in the postoperative period if dissection in the axilla is performed carefully and respects the axillary soft-tissue triangle described. Despite anatomical variations and clinical controversies, it is known that lymph vessels from both breast and upper limb drain to the axilla. This case illustrates the success of axillary sentinel lymph node investigation in a patient with upper limb melanoma after transaxillary breast augmentation. Ruth Maria Graf, M.D., Ph.D. André Ricardo Dall'Oglio Tolazzi, M.D., M.Sc. Paula Giordani Colpo, M.D. Gilvani Azor de Oliveira e Cruz, M.D., Ph.D. Division of Plastic Surgery Hospital de Clínicas School of Medicine Federal University of Paraná Curitiba, Paraná, Brazil

Initial axillary staging of breast cancer using ultrasound‐guided fine needle aspiration: a liquid‐based cytology study

To evaluate the preoperative detection of axillary metastasis combining ultrasound (US)-guided fine needle aspiration cytology (FNAC) and liquid-based cytology (Surepath(®)) to reduce sentinel node procedures. In total, 148 patients with clinically negative lymph nodes and no preoperative therapy were included. All patients underwent preoperative ultrasound of the axilla with FNAC if suspicious lymph nodes were found. Complete axillary lymph node dissection was performed at primary surgery when FNAC was positive. All other patients underwent a sentinel node procedure. US-guided FNAC of the axilla revealed metastasis in 34 (23.0%) of the 148 patients. These 34 patients were 53.1% of all patients (n = 64) with proven axillary lymph node involvement. In 66 patients (44.6%), both ultrasound and histopathology were negative. Overall sensitivity of US-guided FNAC was 50.0%, specificity 100%, positive predictive value 100% and negative predictive value 70.2%. In T1 tumours, all patients referred for sentinel node procedure were node-negative. The correlation between malignant FNAC and histopathology was 100%. US-guided liquid-based FNAC in patients with no clinically positive lymph nodes reduced the necessity for a sentinel node procedure by 23.0%. We advocate that US-guided fine needle aspiration (FNA) combined with liquid-based cytology of axillary lymph nodes should be included in the preoperative staging of breast cancer.

Abstract P1-01-29: Clinical and Histopathological Factors Affecting Failed Sentinel Node Localization in Axillary Staging for Breast Cancer

Abstract Background: Sentinel lymph node biopsy (SLNB) has become the standard of care in axillary staging of clinically node-negative breast cancer patients. We hypothesize that clinical parameters are associated with failure to identify an axillary sentinel lymph node. Methods: We performed a retrospective review of 164 consecutive breast cancer patients who underwent SLNB from March 2008 to January 2010. A superficial injection technique was used as advocated by the UK National Training Programme (NEW START). All patients had lymphoscintigrams. Delayed imaging was performed if initial lymphoscintigram was negative up to 22 hours post-injection. Patient/surgical data, histopathological data and tumour location data were recorded. A univariate and multivariate analysis was performed. Results: Mean time from radiocolloid injection to surgery was 785.10 minutes (SD 435.97). 9/164 patients failed to show nodes on delayed imaging. In 2/9 patients successful SLNB was carried out following subareolar blue dye injection and 5 minute massage. 6/9 patients showed no evidence of radioactivity or blue dye. These patients underwent a stage 2 axillary clearance. 5/6 had multiple node involvement. Age and nodal status were significant factors (P&amp;lt;0.05). For every unit increase in age there was a 9% (CI, 0.84 - 0.99) reduced chance of failed sentinel node localization. Patients with negative nodal status had a 90% (CI, 0.02 - 0.99) reduced risk of failed sentinel node localization than patients with nodal macrometastasis and extracapsular nodal invasion. Weight (p=0.063, CI 0.91 - 1.03), previous breast surgery (p=0.062, CI 0.006 - 1.136) and tumour location (p=0.402, CI 0.03 - 4.17) showed weak association but failed to reach statistical significance. Discussion: Our results suggest that aberrant lymphatic flow secondary to tumour burden increase the chance of failed axillary sentinel node localization. Review of lymphoscintigrams showed that in all failed localizations the radiocolloid persisted around the injection site, showing limited local diffusion only. Similar findings were observed for blue dye injection. We further hypothesize that technical factors at the time of the injection may also play a role. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-29.

Success in sentinel lymph node procedures in obese patients with breast cancer

Background Sentinel lymph node (SLN) biopsy for axillary staging in breast cancer is technically more demanding but of added benefit in obese patients. This retrospective review compares variables and outcomes of SLN staging in obese and nonobese women. Methods From 235 total SLN cases, demographics and clinical and procedural variables were collected and compared in obese (body mass index [BMI] of ≥35, n = 28) and nonobese (BMI ≤25 [n = 84]) patients. Results Overall, the intraoperative false-negative rate was 13.6% and failure to identify SLN occurred in 2 cases (.85%). Although no differences in patient or tumor characteristics were found, obese patients had significantly lower external hotspot counts, first sentinel node counts, and fewer sentinel nodes recovered when compared with the nonobese. Conclusions SLN procedures are successful and accurate for axillary staging in obese women and avoid the added morbidity of axillary lymph node dissection in this higher risk population.

Sentinel node micrometastases in breast cancer do not affect prognosis: a population-based study

Sentinel node biopsy (SNB) for axillary staging in breast cancer allows the application of more extensive pathologic examination techniques. Micrometastases are being detected more often, however, coinciding with stage migration. Besides assessing the prognostic relevance of micrometastases and the need for administering adjuvant systemic and regional therapies, there still seems to be room for improvement. In a population-based analysis, we compared survival of patients with sentinel node micrometastases with those with node-negative and node-positive disease in the era after introduction of SNB. Data from the population-based Eindhoven Cancer Registry were used on all (n = 6803) women who underwent SNB for invasive breast cancer in the Southeast Region of The Netherlands in the period 1996-2006. In 451 patients (6.6%) a sentinel node micrometastasis (pN1mi) was detected and in 126 patients (1.9%) isolated tumor cells (pN0(i+)). Micrometastases or isolated tumor cells in the SNB did not convey any significant survival difference compared with node-negative disease. After adjustment for age, pT, and grade, still no survival difference emerged pN1mi: [HR 0.9 (95% CI, 0.6-1.3)] and pN0(i+): [HR 0.4 (95% CI, 0.14-1.3)] and neither was the case after additional adjustment for adjuvant systemic therapy. Our practice-based study showed that the presence of sentinel node micrometastases in breast cancer patients has hardly any impact on breast cancer overall survival during the first years after diagnosis.

Accuracy of preoperative ultrasound and ultrasound‐guided fine needle aspiration cytology for axillary staging in breast cancer

The aims of this study were to evaluate the accuracy of preoperative ultrasound and ultrasound-guided fine needle aspiration (FNA) cytology (US-FNAC) for detecting axillary metastases, and to assess how often sentinel node biopsy could be avoided. Axillary ultrasound, as a part of routine preoperative staging, was performed in 189 patients with histologically proven breast cancer. US-FNAC was performed on all lymph nodes (LNs) with features suggestive of metastatic disease on ultrasound characteristics and LNs larger than 1 cm regardless of whether the nodes appear normal or abnormal. The cytologic results were compared with the final histological diagnosis. The sensitivity, specificity and positive and negative predictive values of the ultrasound alone of axillary LNs for metastatic breast cancer were 54, 91, 75 and 81%, retrospectively. For the US-FNAC, the respective values were 80, 98, 97 and 84%. Preoperative axillary ultrasound in combination with US-FNAC provides a simple, minimally invasive and reliable approach to the initial determination of the axillary LN status. Those who are US-FNAC positive can be referred for axillary LN dissection without sentinel LN biopsy.

Near infrared photoacoustic detection of sentinel lymph nodes with gold nanobeacons

Detection of sentinel lymph node (SLN) using photoacoustic imaging is an emerging technique for noninvasive axillary staging of breast cancer. Due to the absence of intrinsic contrast inside the lymph nodes, exogenous contrast agents are used for photoacoustic detection. In this work, we have demonstrated near infrared detection of SLN with gold nanobeacons (GNBs) providing the photoacoustic contrast in a rodent model. We found that size dictates the in vivo characteristics of these nanoparticles in SLN imaging. Larger nanobeacons with high payloads of gold were not as efficient as smaller size nanobeacons with lower payloads for this purpose. Colloidal GNBs were designed as a nanomedicine platform with “soft” nature that is amenable to bio-elimination, an essential feature for in vivo efficacy and safety. The GNBs were synthesized as lipid- or polymer-encapsulated colloidal particles incorporating tiny gold nanoparticles (2–4 nm) in three tunable sizes (90 nm, 150 nm and 290 nm). Smaller GNBs were noted trafficking through the lymphatic system and accumulating more efficiently in the lymph nodes in comparison to the bigger nanoagents. At 20 min, the GNBs reached the SLN and were no longer observed within the draining lymphatic vessel. Within 1 h post-injection, the contrast ratio of the lymph nodes with the surrounding blood vessels was 9:1. These findings were also supported by analytical measurements of the ex vivo tissue samples. Results indicate that cumulative nanoparticle deposition in lymph nodes is size dependent and that high payloads of gold, although offering greater contrast in vitro, may yield nanoagents with poor intradermal migration and lymphatic transport characteristics.

ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer

Sentinel lymph node (SLN) biopsy is a selective approach to axillary staging of breast cancer with reduced morbidity. Current detection methods including radioisotope and blue dye show good results but some drawbacks are remaining. Indocyanine green (ICG) fluorescence detection was evaluated as a new method for SLN biopsy in breast cancer allowing both transcutaneous visualization of lymphatic vessels and intraoperative identification of SLN. Forty-three women with clinically node negative breast cancer received subareolar injection of ICG for fluorescence detection of SLN. All patients underwent either planned axillary lymph node dissection (ALND) with SLN biopsy or selective SLN biopsy to determine need for ALND. Clinical feasibility, detection rate, sensitivity, and axillary recurrence after isolated SLN biopsy were analyzed. Overall ICG fluorescence imaging identified 2.0 SLN in average in 42 of 43 patients (detection rate: 97.7%). Metastatic involvement of the SLN was found in 17 of 18 nodal positive patients by conventional histopathology (sensitivity: 94.4%). Immunohistochemistry revealed isolated tumor cells in five further cases. There was only one false-negative case in 43 patients (5.6%). In 17 of 23 overall nodal positive patients, the SLN was the only positive lymph node. After a median follow-up of 4.7 years none of the patients presented with axillary recurrence. ICG fluorescence imaging is a new method for SLN biopsy in breast cancer with acceptable sensitivity and specificity comparable to conventional methods. One advantage of this technique is that it allows transcutaneous visualization of lymphatic vessels and intraoperative lymph node detection without radioisotope.

Sentinel lymph node biopsy in breast cancer guided by indocyanine green fluorescence

Sentinel lymph node (SLN) biopsy with radioisotope and blue dye has been used successfully for axillary staging in breast cancer. This study evaluated the feasibility of fluorescence detection of SLNs with indocyanine green (ICG) for lymphatic mapping and SLN biopsy. Thirty women with breast cancer had a periareolar injection of ICG for fluorescence detection of SLN using a near-infrared camera. Twenty also received (99m)Tc-labelled sulphur radiocolloid for SLN scintigraphy. All patients underwent axillary lymph node dissection. Detection rate and sensitivity of both methods were the study endpoints. Visualization of lymphatic vessels by fluorescence detection depended on the dose of ICG. ICG imaging identified SLNs in 29 of 30 women (detection rate 97 per cent). Nineteen of 21 patients had metastatic SLN involvement (sensitivity 90 per cent) with false-negative results in two. Among the 20 patients who had both methods, ICG fluorescence and radiocolloid identified SLNs in 20 and 17 patients respectively. Metastatic lymph nodes were diagnosed in 12 and ten of 13 patients (sensitivity 92 and 77 per cent). False-negative rates were 8 and 23 per cent respectively. ICG fluorescence allowed transcutaneous imaging of lymphatic vessels and SLN detection, thus combining the advantages of radioisotope and blue dye methods.

Molecular assessment of sentinel lymph node in breast cancer management

Sentinel lymph node biopsy (SLNB) is becoming accepted as standard of care for axillary staging in breast cancer. World Health Organization (WHO) re-classification of axillary metastases into macrometastases, micrometastases and individual tumour cells has highlighted the issues of sampling and further histological examination of the initially negative SLNB. Molecular detection of metastatic breast cancer cells in lymph nodes is now available as a commercial kit for intraoperative use and can resolve the sampling issue. Semiquantitative assessment of axillary lymph node tumour burden can now be made using two separate technologies (histology and reverse transcriptase-polymerase chain reaction). The clinical implications of low metastatic axillary lymph node tumour burden are not clear, and future trials need to include molecular data. The consequences of the availability of molecular assessment are reviewed.

Testing the Feasibility of Intra-Operative Sentinel Lymph Node Touch Imprint Cytology

Sentinel lymph node biopsy is emerging as the new standard for axillary staging in breast cancer. Intra-operative assessment of the sentinel lymph nodes allows immediate completion of axillary dissection during the same anaesthetic. This project was a quality assurance practice to establish feasibility, time-to-report, as well as accuracy of performing intra-operative assessment of sentinel lymph nodes using touch imprint cytology in our centre. This prospective audit included 146 sentinel lymph nodes from 74 consecutive patients with invasive breast cancer. All patients underwent axillary sentinel lymph node biopsy using combined blue dye and radiocolloid technique. Results of intra-operative touch imprint cytology using haematoxylin and eosin staining were compared with the definitive histopathology results. Mean time to report touch imprint cytology was 25.7 +/- 6.4 min (range, 15-40 min). Histopathology demonstrated metastasis in 25 sentinel nodes from 17 (23%) patients. Intra-operative touch imprint cytology detected 15 nodes in 11 patients, giving a sensitivity of 60% (nodes) and 66.7% (patients) and specificity of 99.2% (nodes) and 98.2% (patients) based on the number of nodes and patients involved, respectively. Touch imprint cytology failed to show metastatic involvement in 10 nodes from 6 patients; of these, five nodes had micrometastasis (< 2 mm) and the other five had macrometastasis. One touch imprint cytology positive node contained isolated tumour cells only. Using intra-operative touch imprint cytology made a change in treatment of 11(14.9%) patients, and spared second axillary procedure in 7 (9.4%) patients. Intra-operative sentinel lymph node assessment using touch imprint cytology is feasible within a busy NHS practice. We now offer touch imprint cytology to patients following appropriate counselling.

0090 Axillary staging of breast cancer with the sentinel lymph node (SLN) procedure in over a thousand patients with early breast cancer

0090 Axillary staging of breast cancer with the sentinel lymph node (SLN) procedure in over a thousand patients with early breast cancer