BACKGROUND AND OBJECTIVE: Intraoperative frozen section of the sentinel lymph node (SLN) in clinically node negative breast cancer patients detects metastatic disease and enables axillary lymph node dissection to be performed in the same operative setting. Internationally, the false negative rate (FNR) for SLN biopsy ranges from 5.5% to 43%. The size of SLN metastasis has been identified as a key factor affecting FNR. We review our institutional experience on the accuracy of intraoperative SLN biopsy. METHODS: Data were collected retrospectively from patients undergoing SLN biopsy performed at Singapore General Hospital. The SLN was identified using blue dye, radioisotope or both. Frozen section was performed intraoperatively. When SLN was positive for metastasis on frozen section, completion axillary clearance was performed. False negative cases were defined as patients in whom a negative frozen section result was obtained, whose final permanent paraffin section was positive. We determined the FNR of SLN frozen section and evaluated the factors associated with it. RESULTS: A total of 2202 SLN biopsies were performed between January 2005 and June 2012. There were 89 false negative cases, of which there were 23 (25.8%) cases of isolated tumour cells (ITCs), 49 (55.1%) cases of micrometastasis, and 17 (19.1%) cases of macrometastasis. The overall FNR was 13.5%. FNR was 79.3% in ITCs, 59.8% in micrometastasis, and 3.1% in macrometastatic disease. Non-ductal histological subtype, absence of lymphovascular invasion and the size of SLN metastasis were identified as significant independent factors associated with a higher FNR. CONCLUSIONS: FNRin our institution is acceptable when compared to other large centres. Failure to detect metastasis in frozen section in more than half of our patients was due to ITCs and micrometastasis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND AND OBJECTIVE: Intraoperative frozen section of the sentinel lymph node (SLN) in clinically node negative breast cancerpatients detects metastatic disease and enables axillary lymph node dissection to be performed in the same operative setting. Internationally, the false negative rate (FNR) for SLN biopsy ranges from 5.5% to 43%. The size of SLN metastasis has been identified as a key factor affecting FNR. We review our institutional experience on the accuracy of intraoperative SLN biopsy. METHODS: Data were collected retrospectively from patients undergoing SLN biopsy performed at Singapore General Hospital. The SLN was identified using blue dye, radioisotope or both. Frozen section was performed intraoperatively. When SLN was positive for metastasis on frozen section, completion axillary clearance was performed. False negative cases were defined as patients in whom a negative frozen section result was obtained, whose final permanent paraffin section was positive. We determined the FNR of SLN frozen section and evaluated the factors associated with it. RESULTS: A total of 2202 SLN biopsies were performed between January 2005 and June 2012. There were 89 false negative cases, of which there were 23 (25.8%) cases of isolated tumour cells (ITCs), 49 (55.1%) cases of micrometastasis, and 17 (19.1%) cases of macrometastasis. The overall FNR was 13.5%. FNR was 79.3% in ITCs, 59.8% in micrometastasis, and 3.1% in macrometastatic disease. Non-ductal histological subtype, absence of lymphovascular invasion and the size of SLN metastasis were identified as significant independent factors associated with a higher FNR. CONCLUSIONS: FNRin our institution is acceptable when compared to other large centres. Failure to detect metastasis in frozen section in more than half of our patients was due to ITCs and micrometastasis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
BREAST CANCER; LYMPH NODE PATHOLOGY; SURGICAL PATHOLOGY
Authors: Anne Grabenstetter; Tracy-Ann Moo; Sabina Hajiyeva; Peter J Schüffler; Pallavi Khattar; Maria A Friedlander; Maura A McCormack; Monica Raiss; Emily C Zabor; Andrea Barrio; Monica Morrow; Marcia Edelweiss Journal: Am J Surg Pathol Date: 2019-10 Impact factor: 6.394
Authors: E Martín-Sánchez; E Pernaut-Leza; S Mendaza; A Cordoba; F Vicente-Garcia; I Monreal-Santesteban; J Pérez Vizcaino; M J Díaz De Cerio; N Perez-Janices; I Blanco-Luquin; D Escors; A Ulazia-Garmendia; D Guerrero-Setas Journal: Virchows Arch Date: 2016-04-21 Impact factor: 4.064
Authors: Thalia Petropoulou; Antonia Kapoula; Aikaterini Mastoraki; Aikaterini Politi; Eleni Spanidou-Karvouni; Ioannis Psychogios; Ioannis Vassiliou; Nikolaos Arkadopoulos Journal: Breast Cancer (Dove Med Press) Date: 2017-05-05
Authors: Willard Wong; Illana Rubenchik; Sharon Nofech-Mozes; Elzbieta Slodkowska; Carlos Parra-Herran; Wedad M Hanna; Fang-I Lu Journal: Technol Cancer Res Treat Date: 2019-01-01
Authors: Leonardo Russo; Luis Betancourt; Gabriel Romero; Alí Godoy; Laura Bergamo; Rafael Delgado; Ángela Ruiz; Marianna Gutiérrez; Eduardo Salas; Maria Puzzi Journal: Ecancermedicalscience Date: 2017-10-18