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

Wong, Jolene Si Min; Yong, Wei Sean; Thike, Aye Aye; Iqbal, Jabed; Salahuddin, Ahmed Syed; Ho, Gay Hui; Madhukumar, Preetha; Tan, Benita Kiat Tee; Ong, Kong Wee; Tan, Puay Hoon

doi:10.1136/jclinpath-2014-202799

Cited by 48 publications

(32 citation statements)

References 31 publications

(17 reference statements)

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“…After lymph node removal, surgeons must wait for the immunohistochemical analysis (IHA) results to decide if axillary lymph node dissection is necessary, which usually takes 30-60 min. In some cases, a second operation cannot be avoided because the specificity of frozen section rapid pathologic examination cannot reach 100% and the false negative rate is at least 4% [36]. Isabelle et al first used Raman spectra and infrared images to detect the lymph node excision during head and neck tumor surgeries [37] and showed that lymph nodes with metastatic cancer have greater nucleic acid and less lipid and carbohydrate content than normal lymph nodes.…”

Section: Raman Spectroscopy In Tissuesmentioning

confidence: 99%

The Clinical Application of Raman Spectroscopy for Breast Cancer Detection

Gao

Han

et al. 2017

Journal of Spectroscopy

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Raman spectroscopy has been widely used as an important clinical tool for real-time in vivo cancer diagnosis. Raman information can be obtained from whole organisms and tissues, at the cellular level and at the biomolecular level. The aim of this paper is to review the newest developments of Raman spectroscopy in the field of breast cancer diagnosis and treatment. Raman spectroscopy can distinguish malignant tissues from noncancerous/normal tissues and can assess tumor margins or sentinel lymph nodes during an operation. At the cellular level, Raman spectra can be used to monitor the intracellular processes occurring in blood circulation. At the biomolecular level, surface-enhanced Raman spectroscopy techniques may help detect the biomarker on the tumor surface as well as evaluate the efficacy of anticancer drugs. Furthermore, Raman images reveal an inhomogeneous distribution of different compounds, especially proteins, lipids, microcalcifications, and their metabolic products, in cancerous breast tissues. Information about these compounds may further our understanding of the mechanisms of breast cancer.

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Section: Raman Spectroscopy In Tissuesmentioning

confidence: 99%

The Clinical Application of Raman Spectroscopy for Breast Cancer Detection

Gao

Han

et al. 2017

Journal of Spectroscopy

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“…The use of FS is accompanied with many drawbacks such as considerable waiting time, tissue loss, and cost. Furthermore, false-negative rates are always a concern 8. Intraoperative imprint cytology (IC) has also been suggested as a less expensive and equally accurate alternative to FS; this technique can also be performed on lymph nodes replaced by fat 9,10.…”

Section: Introductionmentioning

confidence: 99%

Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer

Petropoulou¹,

Kapoula²,

Mastoraki³

et al. 2017

BCTT

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IntroductionSentinel lymph node (SLN) biopsy is the gold standard for surgical staging of the axilla in breast cancer (BC). Frozen section (FS) remains the most popular means of intraoperative SLN diagnosis. Imprint cytology (IC) has also been suggested as a less expensive and equally accurate alternative to FS. The aim of our study was to perform a direct comparison between IC and FS on the same SLNs of BC cases operated in a single center by the same surgical team.Materials and methodsInto this prospective study we enrolled 60 consecutive patients with histologically proven T1–T3 BC and clinically negative axilla. Sentinel nodes were detected using a standard protocol. The SLN(s) was always assessed by IC as well as FS analysis and immunohistochemistry. Nevertheless, all intraoperative decisions were based on FS analysis.ResultsDuring the study period 60 patients with invasive BC were registered, with 80 SLNs harvested. Mean number of SLN(s) identified for each patient was 1.33. The sensitivity and specificity were 90% and 100%, respectively, for IC, and 80% and 100% for FS. Relevant positive/negative predictive values were 100%/98% for IC and 100%/96.15%, respectively, for FS. Overall accuracy was 98% for IC and 97% for FS. Therefore, statistically significant difference between the two methods in the detection of positive nodes was not elucidated (p=1.000).ConclusionsIC appeared to be marginally more sensitive than FS in detecting SLN metastatic activity. Overall accuracy was 98.75%. With regard to the primary lesion characteristics, we conclude that initial lesion size and lymphovascular invasion play a pivotal role in metastatic involvement of the SLN with the dimensions of metastasis bearing no correlation with tumor size. Therefore, IC appears to be a sensitive and accurate method for the intraoperative assessment of SLN in BC patients, but further studies are required to confirm this interesting data.

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“…В Сингапурской больнице общего профиля Вонгом и др. был проведен ретроспективный анализ 2202 биопсий СЛУ из 2174 больных раком молочной железы, в течение 7 лет, результаты данного исследования подтвердили взаимосвязь между размером метастаза СЛУ и риском ложноотрицательных заключений после замораживания ткани ЛУ [18]. Они определили общую частоту ложноотрицательных заключений -13,5%, частота же ложноотрицательных заключений при макрометастазах была значительно ниже, и составила всего 3,1%.…”

Section: интраоперационная оценка сигнальных лимфатических узлов (слу)unclassified

The role of sentinel lymph nodes in breast cancer. The current state of the problem.

2017

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Sentinel lymph nodes (SLN) biopsy is currently the standard procedure for axillary staging in patients with invasive breast cancer and clinically negative lymph nodes (cN0). Historically, all patients with a positive sentinel lymph node (SLN) undergo classical axillary lymph node dissection (ALND). A randomized clinical trial in patients with breast cancer with clinical T1-2N0M0, with positive SLN afterwards undergo classical ALND showed that women diagnosed with T1-T2 and cN0 who underwent breast-conserving surgery and radiation therapy can safely avoid ALND. The main goal of SLN examination should be the detection of all macrometastases (> 2 mm). The role and timing of SLN in patients who received neoadjuvant polychemotherapy is still controversial and continues being studied in clinical trials.Keywords: breast cancer -sentinel lymph node -axillary lymphadenectomy. ТҰЖЫРЫМДАМАБүгінгі таңда сүт безінің қатерлі ісігімен және клиникалық теріс лимфа түйіндерімен ауыратын науқастарға сигналды лимфатикалық түйіндердің биопсиясын (СЛТБ) жүргізу стандартты рәсім болып табылады. Тарихқа жүгінсек, оң сигналды лимфотүйіндері (ОСЛ) бар барлық науқастар классикалық аксилярлы лимфодиссекцияга (АЛД) ұшырайды. T1-2N0M0 клиникасымен жүретін, соңында оң ОСЛ бар, классикалы лимфодиссекцияға үшырайтын (ACOSOG Z0011) сүт бездерінің қатерлі ісіктерінің рандомизирленген клинкалық зерттеулері T1-T2 және СN0 диагнозымен ағзаны сақтап қалушы және сәулелі терапия жүргізілген әйелдер САЛД-дан қауіпсіз құтылса болады. БСЛУ-дың негізгі мақсаты болып барлық макрометастаздарды табу болып келеді (> 2 мм). Неоадьювантты полихимиотерапияны(НАПХТ) қабылдаған науқастарға уақытша БСЛУ жүргізудің маңызы және мерзімі даулы болып келеді, және де әдеттегідей клиникалық сынауларда зерттелуде.Маңызды сөздер: сүт безінің қатерлі ісігі -сигналды лимфатикалық түйін -аксилярлы лимфодиссекция. РОЛЬ СИГНАЛЬНЫХ ЛИМФАТИЧЕСКИХ УЗЛОВ ПРИ РАКЕ МОЛОЧНОЙ ЖЕЛЕЗЫ. СОВРЕМЕННОЕ СОСТОЯ- РЕЗЮМЕБиопсия сигнальных лимфатических узлов (БСЛУ) на сегодняшний день является стандартной процедурой стадирования у боль-ных с инвазивным раком молочной железы и клинически негативными лимфоузлами (сN0). Исторически так сложилось, что все пациенты с положительным сигнальным лимфоузлом (СЛУ) подвергаются классической аксиллярной лимфодиссекции (АЛД). Рандомизированное клиническое исследование у больных раком молочной железы с клиническим T1-2N0M0, с позитивными СЛУ в последствии, подвергшихся классической АЛД (ACOSOG Z0011) показало, что женщины с диагнозом T1-T2 и сN0, которым проведена органосохраняющая операция и лучевая терапия может безопасно избежать АЛД. Основной целью БСЛУ должно быть обнаружение всех макрометастазов (> 2 мм). Роль и временные сроки проведения БСЛУ у пациентов, которые получили неоадъювантную полихимиотерапию (НАПХТ) является пока спорным, и по-прежнему изучаются в клинических испытаниях. Биоматериал СЛУ, полученный от пациентов с инвазивным раком молочной железы, прошедших неоадъювантную химиотерапию создают некоторые трудности для патологоанатомов.Кл...

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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

Abstract: 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.

Cited by 48 publications

References 31 publications

The Clinical Application of Raman Spectroscopy for Breast Cancer Detection

The Clinical Application of Raman Spectroscopy for Breast Cancer Detection

Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer

The role of sentinel lymph nodes in breast cancer. The current state of the problem.

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