Breast cancer detection in axillary sentinel lymph nodes: the impact of the method of pathologic examination

Calhoun, Benjamin C.; Chambers, Karinn; Flippo‐Morton, Teresa S.; Livasy, Chad; Armstrong, Edward J.; Symanowski, James T.; Sarantou, Terry; Greene, Frederick L.; White, Richard L.

doi:10.1016/j.humpath.2014.09.004

Cited by 5 publications

(2 citation statements)

References 16 publications

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“…Generating one tissue ribbon from each block satisfies that recommendation. The College of American Pathologists recommends a more intensive step-sectioning protocol be reserved for sentinel lymph nodes in breast carcinoma and melanoma, which enhances detection of micrometastases [8][9][10]13].…”

Section: Discussionmentioning

confidence: 99%

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Positive Lymph Node Counts in American Thyroid Association Low‐Risk Papillary Thyroid Carcinoma Patients

et al. 2020

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Background Current American Thyroid Association (ATA) guidelines state that patients with intermediate‐risk papillary thyroid cancer (PTC) may benefit from remnant ablation. One criterion for intermediate‐risk classification is >5 positive lymph nodes (LNs). We investigate whether performing step‐sectioning of LNs increases the metastatic detection rate, thereby influencing ATA risk of recurrence (ROR) classification. Methods A retrospective review was conducted of cases in which ≥ 5 LNs were removed during thyroidectomy and ≤5 LNs were found positive for PTC. Step‐sectioning was performed on the original tissue blocks. All slides were re‐reviewed by a senior pathologist. Results Twenty patients met study criteria. Step‐sectioning significantly increased LN yield compared to standard sectioning. In total, we found 12 new positive lymph nodes; seven (58%) were in totally new lymph nodes, while five (42%) were in lymph nodes previously read as negative. All newly discovered metastases were classified as micrometastases (≤2 mm). Of the 15 patients originally classified as low‐risk, the step‐sectioning protocol impacted two patients (13%), increasing ROR stratification. Conclusion Intensive step‐sectioning reveals additional micrometastases. More detailed analysis did not identify clinically significant nodal disease likely to impact the clinical course of patients in this study. Our study supports current standards of pathology specimen handling related to LN assessment and the impact on ATA ROR classification. Nonetheless, it is important for clinicians to understand their institution's sectioning protocol utilized to report positive and total LN counts, which could impact ATA risk stratification and denote the comprehensive nature of the LN dissection that was performed.

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Section: Discussionmentioning

confidence: 99%

“…How often would more rigorous pathologic examination impact the total and positive lymph node counts? [8–10] Our aim was to examine the potential impact to ATA ROR classification and association with outcome as well as the cost and time of more detailed lymph node sectioning.…”

Section: Introductionmentioning

confidence: 99%

Positive Lymph Node Counts in American Thyroid Association Low‐Risk Papillary Thyroid Carcinoma Patients

et al. 2020

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Lymph Node Metastases

Lester¹

2016

Diagnostic Pathology: Breast

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The inextricable axis of targeted diagnostic imaging and therapy: An immunological natural history approach

Cope

Abbruzzese

Sanders

et al. 2016

Nuclear Medicine and Biology

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Summary In considering the challenges of approaches to clinical imaging, we are faced with choices that sometimes are impacted by rather dogmatic notions about what is a better or worse technology to achieve the most useful diagnostic image for the patient. For example, is PET or SPECT most useful in imaging any particular disease dissemination? The dictatorial approach would be to choose PET, all other matters being equal. But is such a totalitarian attitude toward imaging selection still valid? In the face of new receptor targeted SPECT agents one must consider the remarkable specificity and sensitivity of these agents. 99mTc-Tilmanocept is one of the newest of these agents, now approved for guiding sentinel node biopsy (SLNB) in several solid tumors. Tilmanocept has a Kd of 3×10−11 M, and it specificity for the CD206 receptor is unlike any other agent to date. This coupled with a number of facts, that specific disease-associated macrophages express this receptor (100 to 150 thousand receptors), the receptor has multiple binding sites for tilmanocept (>2 sites per receptor) and that these receptors are recycled every 15 minutes to bind more tilmanocept (acting as intracellular “drug compilers” of tilmanocept into non-degraded vesicles), give serious pause as to how we select our approaches to diagnostic imaging. Clinically, the size of SLNs varies greatly, some, anatomically, below the machine resolution of SPECT. Yet, with tilmanocept targeting, the SLNs are highly visible with macrophages stably accruing adequate 99mTc-tilmanocept counting statistics, as high target-to-background ratios can compensate for spatial resolution blurring. Importantly, it may be targeted imaging agents per se, again such as tilmanocept, which may significantly shrink any perceived chasm between the imaging technologies and anchor the diagnostic considerations in the targeting and specificity of the agent rather than any lingering dogma about the hardware as the basis for imaging approaches. Beyond the elements of imaging applications of these agents is their evolution to therapeutic agents as well, and even in the neo-logical realm of theranostics. Characteristics of agents such as tilmanocept that exploit the natural history of diseases with remarkably high specificity are the expectations for the future of patient- and disease-centered diagnosis and therapy.

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Breast cancer detection in axillary sentinel lymph nodes: the impact of the method of pathologic examination

Cited by 5 publications

References 16 publications

Positive Lymph Node Counts in American Thyroid Association Low‐Risk Papillary Thyroid Carcinoma Patients

Positive Lymph Node Counts in American Thyroid Association Low‐Risk Papillary Thyroid Carcinoma Patients

Lymph Node Metastases

The inextricable axis of targeted diagnostic imaging and therapy: An immunological natural history approach

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