Intraoperative frozen section analysis is a reliable procedure by which a high percentage of sentinel lymph node metastases can be detected in breast cancer patients without false positive results. This allows the surgeon to perform an immediate axillary lymph node dissection in case of positive SNs. In up to 10% of cases, the final paraffin sections will reveal micrometastases that were not detected by the frozen section, and in these patients axillary lymph node dissection will have to be performed in a second session. The imprint method is significantly less sensitive than the frozen section but may be used as an alternative when frozen section is not possible.

US-guided excision seems to be superior to wire-guided excision with respect to margin clearance of mammographically detected and US-visible nonpalpable breast cancers. Patients do not have to undergo the unpleasant wire placement before surgery.

Background: The potential morbidity of an axillary lymph node dissection in patients with breast cancer can be avoided in patients with a negative sentinel node (SN).

ObjectiveTo assess the value of diagnostic laparoscopy (DL) and laparoscopic ultrasonography (LUS) in the staging and selection of patients with colorectal liver metastasis. Summary Background DataPreoperative imaging modalities such as ultrasound, computed tomography, and magnetic resonance imaging are limited in the assessment of the number and exact location of hepatic metastases and in the detection of extrahepatic metastatic disease. Consequently, the surgeon is often faced with a discrepancy between preoperative imaging results and perioperative findings, resulting in either a different resection than planned or no resection at all. MethodsFifty consecutive patients were planned for DL and LUS in a separate surgical sitting to assess the resectability of their liver metastases. All patients were considered to be candidates for resection on the basis of preoperative imaging studies. ResultsLaparoscopy could not be performed in 3 of the 50 patients because of dense adhesions. The remaining 47 patients underwent DL. On the basis of DL and LUS, 18 (38%) patients were ruled out as candidates for resection. Of the 29 patients who subsequently underwent open exploration and intraoperative ultrasonography, another 6 (13%) were deemed to have unresectable disease. ConclusionsThe combination of DL and LUS significantly improves the selection of candidates for resection of colorectal liver metastases and effectively reduces the number of unnecessary laparotomies.Resection of colorectal metastases in selected patients is a worthwhile undertaking: a survival advantage has been shown if metastases are resected with curative intent. 1,2However, 62% to 85% of patients will not survive beyond 5 years after resection of liver metastases.3-6 Tumor recurrence after resection of the liver metastases occurs in 48% to 88% of patients who die of their metastatic disease, 7-9 and most often within the first year after resection.Only a small proportion of patients with hepatic colorectal metastases are candidates for resection with curative intent. Accurate staging is mandatory in the selection process. Preoperative imaging modalities such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are limited in the assessment of the number and exact location of hepatic metastases and in the detection of extrahepatic metastatic disease. Consequently, the surgeon is often faced with a discrepancy between preoperative imaging results and perioperative findings, resulting in either a different resection than planned or no resection at all. 10Laparoscopy may reveal extrahepatic intraabdominal dissemination, such as peritoneal implants and lymph node metastases, that is often not seen on a preoperative CT scan. When necessary, guided biopsies can be taken. Direct contact intraoperative ultrasonography (IOUS) has proven to be more sensitive in detecting liver metastases than preoperative imaging.11-13 Laparoscopic ultrasonography (LUS) therefore seems to be a logical addition to diagnostic laparoscopy (DL) to dete...

Aims-To evaluate in detail the extent to which step sectioning and immunohistochemical examination of sentinel lymph nodes (SNs) in patients with breast cancer reveal additional node positive patients, to arrive at a sensitive yet workable protocol for histopathological SN examination. Methods-This study comprised 86 women with one or more positive SN after a successful SN procedure for clinical stage T1-T2 invasive breast cancer. SNs were lamellated into pieces of approximately 0.5 cm in size. One initial haematoxylin and eosin (H&E) stained central cross section was made for each block. When negative, four step ribbons were cut at intervals of 250 µm. One section from each ribbon was stained with H&E, and one was used for immunohistochemistry (IHC). Results-When taking the cumulative total of detected metastases at level 5 as 100%, the percentage of SN positive patients increased from 80%, 83%, 85%, 87% to 88% in the H&E sections through levels 1 to 5, and with IHC these values were 86%, 90%, 94%, 98%, and 100%. Three of nine patients in whom metastases were detected at levels 3-5 only had metastases in the subsequent axillary lymph node dissection. Conclusions-Multiple level sectioning of SNs (five levels at 250 µm intervals) and the use of IHC detects additional metastases up to the last level. Although more levels of sectioning might increase the yield even further, this protocol ensures a reasonable workload for the pathologist with an acceptable sensitivity when compared with the published literature. (J Clin Pathol 2001;54:550-552)

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