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01-11-2010 | Breast Oncology

Pathological Processing Techniques and Final Diagnosis of Breast Cancer Sentinel Lymph Nodes

Authors: Florian Rudolf Fritzsche, MD, Tanja Reineke, MD, Lars Morawietz, MD, Glen Kristiansen, MD, Manfred Dietel, MD, Daniel Fink, MD, Christoph Rageth, MD, Christoph Honegger, MD, Rosmarie Caduff, MD, Holger Moch, MD, Zsuzsanna Varga, MD

Published in: Annals of Surgical Oncology | Issue 11/2010

Abstract

Background

Recommendations for intraoperative and postoperative breast sentinel lymph node (SLN) processing differ widely. Micrometastases and isolated tumor cells (ITC) have recently been proposed as prognostically and therapeutically relevant. We compared 3 SLN protocols with regard to intraoperative and postoperative diagnosis.

Materials and Methods

SLN in cohort I (270 patients) were intraoperatively assessed by stereomicroscopy. Intraoperative frozen section (IFS) was used only in stereomicroscopically suspicious SLN. In cohort II (197 patients), all SLN were examined with only 1 IFS. Final SLN workup in cohorts I and II consisted of complete step sectioning with immunohistochemistry. In cohort III (268 patients) 2 or more IFS were performed followed by 3 step sections and immunohistochemistry.

Results

pN1 stages were significantly higher in cohorts I and II (33.3% and 34.0% respectively) than in cohort III (24.6%). Intraoperative false negativity for the detection of metastases (pN1) ranged from 54.4% (cohort I) and 35.8% (cohort II) to 21.2% (cohort III). In contrast, ITC were detected significantly more frequently in cohort I (9.3%) and cohort II (14.7%) than in cohort III (1.9%).

Conclusions

Higher rates of SLN metastases and ITC in cohort I/II compared to cohort III suggest that IFS may result in tissue loss thus increasing the risk of missing metastases. Sparse IFS but complete postoperative SLN workup with step sectioning and immunohistochemistry provides more accurate information regarding minimal disease in SLN, but often results in delayed axillary lymph node dissection. This is important for preoperative patient information and recommendations in SLN processing protocols.

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Title: Pathological Processing Techniques and Final Diagnosis of Breast Cancer Sentinel Lymph Nodes
Authors: Florian Rudolf Fritzsche, MD
Tanja Reineke, MD
Lars Morawietz, MD
Glen Kristiansen, MD
Manfred Dietel, MD
Daniel Fink, MD
Christoph Rageth, MD
Christoph Honegger, MD
Rosmarie Caduff, MD
Holger Moch, MD
Zsuzsanna Varga, MD
Publication date: 01-11-2010
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 11/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-010-1097-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pathological Processing Techniques and Final Diagnosis of Breast Cancer Sentinel Lymph Nodes

Abstract

Background

Materials and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and Methods

Results

Conclusions

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