Top

Published in:

Open Access 01-12-2022 | Metastasis | Research

Is sentinel lymph node biopsy without frozen section in early stage breast cancer sufficient in accordance with ACOSOG-Z0011? A retrospective review from King Chulalongkorn Memorial Hospital

Authors: Nattanan Treeratanapun, Bhoowit Lerttiendamrong, Voranaddha Vacharathit, Kasaya Tantiphlachiva, Phuphat Vongwattanakit, Sopark Manasnayakorn, Mawin Vongsaisuwon

Published in: BMC Surgery | Issue 1/2022

Abstract

Background

In 2021, there is an increased global trend for sending sentinel lymph node biopsy (SLNB) specimens for permanent section (PS) without intraoperative frozen sections (FS). This pilot study conducted in Thailand determines the re-operation rate for SLNB without FS.

Method

We retrospectively reviewed 239 SLNB cases without FS at King Chulalongkorn Memorial Hospital from April 2016 to April 2021. The patients were diagnosed with primary invasive breast cancer with clinically negative nodes. The clinical nodal status was assessed from physical examination. The re-operation rate was determined by the number of positive SLNs; where 3 more nodal metastases were subjected to a second surgical procedure.

Result

Between April 2016 and April 2021, 239 patients who had undergone SLNB in accordance with ACOSOG Z0011 criteria with PS alone was enrolled. A total of 975 SLNs were removed from these 239 patients, with an average of 4.15 nodes per patient. Out of 239 patients, 21 (8.8%) and 6 (2.5%) had metastatic disease in 1 and 2 nodes, respectively. The remaining 212 (88.7%) patients had no nodal metastasis. None of the patients were subjected to a second surgical procedure.

Conclusion

We conclude that the implementation of SLNB with PS analysis alone in patients who satisfy the ACOSOG Z0011 criteria, with a re-operation rate of 0%, does not have outcomes that would be altered by the standard of care additional FS analysis. With ommision of FS analysis, operation cost, operative time and anesthetic side effects are projected to decrease.

Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. https://doi.org/10.3322/caac.21660.CrossRefPubMed

Waks AG, Winer EP. Breast cancer treatment: a review. JAMA. 2019;321(3):288–300. https://doi.org/10.1001/jama.2018.19323.CrossRefPubMed

Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23(30):7703–20. https://doi.org/10.1200/JCO.2005.08.001.CrossRefPubMed

Wang Z, Wu LC, Chen JQ. Sentinel lymph node biopsy compared with axillary lymph node dissection in early breast cancer: a meta-analysis. Breast Cancer Res Treat. 2011;129(3):675–89. https://doi.org/10.1007/s10549-011-1665-1.CrossRefPubMed

Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA. 2017;318(10):918–26. https://doi.org/10.1001/jama.2017.11470.CrossRefPubMedPubMedCentral

Chao C, Wong SL, Ackermann D, et al. Utility of intraoperative frozen section analysis of sentinel lymph nodes in breast cancer. Am J Surg. 2001;182(6):609–15. https://doi.org/10.1016/s0002-9610(01)00794-2.CrossRefPubMed

Canavese G, Bruzzi P, Catturich A, et al. Sentinel lymph node biopsy versus axillary dissection in node-negative early-stage breast cancer: 15-year follow-up update of a randomized clinical trial. Ann Surg Oncol. 2016;23(8):2494–500. https://doi.org/10.1245/s10434-016-5177-4.CrossRefPubMed

Miltenburg DM, Miller C, Karamlou TB, Brunicardi FC. Meta-analysis of sentinel lymph node biopsy in breast cancer. J Surg Res. 1999;84(2):138–42. https://doi.org/10.1006/jsre.1999.5629.CrossRefPubMed

Godazande G, Moradi S, Naghshvar F, Shojaee L. Is necessary intraoprative frozen section in sentinel lymph node biopsy for breast cancer patients? Asian Pac J Cancer Prev. 2020;21(3):647–51. https://doi.org/10.31557/APJCP.2020.21.3.647.CrossRefPubMedPubMedCentral

10.

Bishop JA, Sun J, Ajkay N, Sanders MA. Decline in frozen section diagnosis for axillary sentinel lymph nodes as a result of the american college of surgeons oncology group Z0011 Trial. Arch Pathol Lab Med. 2016;140(8):830–5. https://doi.org/10.5858/arpa.2015-0296-OA.CrossRefPubMed

11.

Jung SM, Woo J, Ryu JM, et al. Is the intraoperative frozen section analysis of sentinel lymph nodes necessary in clinically negative node breast cancer? Ann Surg Treat Res. 2020;99(5):251–8. https://doi.org/10.4174/astr.2020.99.5.251.CrossRefPubMedPubMedCentral

12.

Holck S, Galatius H, Engel U, Wagner F, Hoffmann J. False-negative frozen section of sentinel lymph node biopsy for breast cancer. Breast. 2004;13(1):42–8. https://doi.org/10.1016/S0960-9776(03)00124-3.CrossRefPubMed

13.

Geertsema D, Gobardhan PD, Madsen EV, et al. Discordance of intraoperative frozen section analysis with definitive histology of sentinel lymph nodes in breast cancer surgery: complementary axillary lymph node dissection is irrelevant for subsequent systemic therapy. Ann Surg Oncol. 2010;17(10):2690–5. https://doi.org/10.1245/s10434-010-1052-x.CrossRefPubMedPubMedCentral

14.

Wong J, Yong WS, Thike AA, et al. False negative rate for intraoperative sentinel lymph node frozen section in patients with breast cancer: a retrospective analysis of patients in a single Asian institution. J Clin Pathol. 2015;68(7):536–40. https://doi.org/10.1136/jclinpath-2014-202799.CrossRefPubMed

15.

Jensen AJ, Naik AM, Pommier RF, Vetto JT, Troxell ML. Factors influencing accuracy of axillary sentinel lymph node frozen section for breast cancer. Am J Surg. 2010;199(5):629–35. https://doi.org/10.1016/j.amjsurg.2010.01.017.CrossRefPubMed

16.

Layfield DM, Agrawal A, Roche H, Cutress RI. Intraoperative assessment of sentinel lymph nodes in breast cancer. Br J Surg. 2011;98(1):4–17. https://doi.org/10.1002/bjs.7229.CrossRefPubMed

17.

Jaafar H. Intra-operative frozen section consultation: concepts, applications and limitations. Malays J Med Sci. 2006;13(1):4–12.PubMedPubMedCentral

18.

Hashmi AA, Faridi N, Khurshid A, et al. Accuracy of frozen section analysis of sentinel lymph nodes for the detection of Asian breast cancer micrometastasis - experience from Pakistan. Asian Pac J Cancer Prev. 2013;14(4):2657–62. https://doi.org/10.7314/apjcp.2013.14.4.2657.CrossRefPubMed

19.

Yoon KH, Park S, Kim JY, et al. Is the frozen section examination for sentinel lymph node necessary in early breast cancer patients? Ann Surg Treat Res. 2019;97(2):49–57. https://doi.org/10.4174/astr.2019.97.2.49.CrossRefPubMedPubMedCentral

20.

Ban EJ, Lee JS, Koo JS, Park S, Kim SI, Park BW. How many sentinel lymph nodes are enough for accurate axillary staging in t1–2 breast cancer? J Breast Cancer. 2011;14(4):296–300. https://doi.org/10.4048/jbc.2011.14.4.296.CrossRefPubMedPubMedCentral

21.

Bevilacqua JL, Kattan MW, Fey JV, Cody HS 3rd, Borgen PI, Van Zee KJ. Doctor, what are my chances of having a positive sentinel node? A validated nomogram for risk estimation. J Clin Oncol. 2007;25(24):3670–9. https://doi.org/10.1200/JCO.2006.08.8013.CrossRefPubMed

22.

Li H, Tang L, Chen Y, Mao L, Xie H, Wang S, Guan X. Development and validation of a nomogram for prediction of lymph node metastasis in early-stage breast cancer. Gland Surg. 2021;10(3):901–13. https://doi.org/10.21037/gs-20-782.CrossRefPubMedPubMedCentral

23.

Fanizzi A, Pomarico D, Paradiso A, Bove S, Diotaiuti S, Didonna V, Giotta F, La Forgia D, Latorre A, Pastena MI, Tamborra P, Zito A, Lorusso V, Massafra R. Predicting of sentinel lymph node status in breast cancer patients with clinically negative nodes: a validation study. Cancers (Basel). 2021;13(2):352. https://doi.org/10.3390/cancers13020352.CrossRefPubMed

24.

Nimboriboonporn A, Sa-nguanraksa D, Samarnthai N, Thumrongtaradol T, Phumphuang S, O-charoenrat P. Predictive factors for sentinel lymph node metastasis and validation of memorial sloan-kettering cancer center nomogram in Thai breast cancer patients: predictive factors for sentinel node metastasis. Thai J Surg. 2020;41(2):29–33.

25.

Marino MA, Avendano D, Zapata P, Riedl CC, Pinker K. Lymph node imaging in patients with primary breast cancer: concurrent diagnostic tools. Oncologist. 2020;25(2):e231–42. https://doi.org/10.1634/theoncologist.2019-0427.CrossRefPubMed

26.

Bae MS, Shin SU, Song SE, Ryu HS, Han W, Moon WK. Association between US features of primary tumor and axillary lymph node metastasis in patients with clinical T1–T2N0 breast cancer. Acta Radiol. 2018;59(4):402–8. https://doi.org/10.1177/0284185117723039.CrossRefPubMed

27.

Cutuli B, Velten M, Martin C. Assessment of axillary lymph node involvement in small breast cancer: analysis of 893 cases. Clin Breast Cancer. 2001;2(1):59–66. https://doi.org/10.3816/CBC.2001.n.012.CrossRefPubMed

Title: Is sentinel lymph node biopsy without frozen section in early stage breast cancer sufficient in accordance with ACOSOG-Z0011? A retrospective review from King Chulalongkorn Memorial Hospital
Authors: Nattanan Treeratanapun
Bhoowit Lerttiendamrong
Voranaddha Vacharathit
Kasaya Tantiphlachiva
Phuphat Vongwattanakit
Sopark Manasnayakorn
Mawin Vongsaisuwon
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Metastasis
Breast Cancer
Breast Cancer
Published in: BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-022-01709-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Is sentinel lymph node biopsy without frozen section in early stage breast cancer sufficient in accordance with ACOSOG-Z0011? A retrospective review from King Chulalongkorn Memorial Hospital

Abstract

Background

Method

Result

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Result

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Role of protective stoma after primary anastomosis for generalized peritonitis due to perforated diverticulitis—DIVERTI 2 (a prospective multicenter randomized trial): rationale and design (nct04604730)

Comparison between endoscopic mucosal resection with a cap and endoscopic submucosal dissection for rectal neuroendocrine tumors

Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) vs CRS alone for treatment of endometrial cancer with peritoneal metastases: a multi-institutional study from PSOGI and BIG RENAPE groups

Analysis of factors influencing cervical lymph node metastasis of papillary thyroid carcinoma at each lateral level

Clinical analysis of subxiphoid single-port thoracoscopic surgery for simultaneous bilateral lung lesion resection

Efficacy of a perfused cadaver model for simulated trauma resuscitation in advanced surgical skills training