Improved Detection of Metastases by Step Sectioning and Immuno-Histochemical Staining of Axillary Sentinel Nodes in Patients with Breast Carcinoma

Ensani, Fereshteh; Enayati, Ladan; Rajabiani, Afsaneh; Omranipour, Ramesh; Alavi, Nasrinalsadat; Mosahebi, Sara

doi:10.7314/apjcp.2013.14.10.5731

Cited by 7 publications

(5 citation statements)

References 29 publications

(32 reference statements)

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“…Cytokeratin (CK) AE1/AE3 is the most commonly used ancillary tool to screen the archived sections between hematoxylin and eosin (H&E) slides for any occult metastases. 3,6,7 We present the first report of two cases in which metastatic carcinoma displayed negative staining by our standard reflex pan-keratin marker (AE1/AE3) and positive staining using additional cytokeratin stains. This highlights the pitfall in relying on a single immunohistochemical stain to identify nodal metastases.…”

Section: Introductionmentioning

confidence: 89%

A Note of Caution

et al. 2015

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Sentinel lymph node biopsy is the current standard procedure used to stage patients with breast cancer. The best histological method in evaluating sentinel nodes is highly debated among institutions and is thus not standardized. The optimal histological analysis is a balance between comprehensive evaluation of the sentinel nodes and cost effectiveness. One commonly used approach is serial sectioning and alternately staining with hemotoxylin and eosin and AE1/AE3 cytokeratin immunohistochemistry analysis. We report 2 cases of metastatic carcinoma demonstrating negative staining for AE1/AE3. This observation highlights a rare but potential pitfall to this commonly used strategy in assessing sentinel lymph node biopsies in breast cancer.

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Section: Introductionmentioning

confidence: 89%

A Note of Caution

et al. 2015

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“…The fragments were then set in individual histological cassettes, undergoing dehydration, clearing and paraffin inclusion [13].…”

Section: Sample Processingmentioning

confidence: 99%

Metastasis of Mammary Carcinoma in Bitches: Evaluation of the Sentinel Lymph Node Technique

Beserra¹,

Grandi²,

Düfloth³

et al. 2016

ABCR

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In recent years the development of extremely accurate techniques for the removal of lymph nodes has been seen, such as the Sentinel Lymph Node Biopsy (SLNB) technique. The technique is based on the staggered progression occurring in the lymphatic drainage of neoplasias, and is currently the main prognostic and diagnostic factor in women suffering from mammary carcinoma. This research aims at assessing the sentinel lymph node biopsy accuracy in female dogs suffering from mammary carcinoma. Forty-one dogs with cytological diagnosis of the tumor were used in the research. After injecting a Patent Blue V dye, mastectomy was conducted jointly with lymphadenectomy (for both sentinel and non-sentinel lymph nodes). The material was then serially sectioned and microscopically evaluated by routine H&E stain and immunohistochemical study with the markers for pancytokeratin AE1/AE3 and myoepithelial cells CK14. The study revealed that 46.3% (19/41) of the animals presented nodal metastasis. The sensitivity and specificity values found for SLNB were respectively 89.5% and 100%, with a kappa coefficient of 0.90 and p < 0.0001. Therefore, the SLNB technique offers high sensitivity in the early detection of metastases, allowing higher precision in the staging of oncological patients and, therefore, offering higher chances of survival.

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“…Some authors propose just one cut, and others suggest the whole LN sectioning. This can impair the implementation of LN micrometastases search at pathology laboratories due to the work overload caused by this procedure [15][16][17][18] . In either way, when searching for LN micrometastases, it is recommended IHC using anti-cytokeratin antibodies as it increases the micrometastases detection rate 19,20 .…”

Section: Discussionmentioning

confidence: 99%

“…Other studies assessing the presence of micrometastases, not only in GC but also in colonic, esophageal, head and neck, and gynecological tumors, also observed the same findings. Such studies attest that, regardless of the tumor staging, the conventional histological evaluation, which is based on just one cut in the LN structure, does not stage the metastatic LN involvement adequately 13,15,16,25 .…”

Section: Discussionmentioning

confidence: 99%

Impact of multisection and immunohistochemistry in lymph node staging of Gastric Carcinoma – Case series

Santos

Drummond-Lage

Wainstein

et al. 2020

Sci Rep

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Gastric carcinoma (GC) locoregional recurrence may occur even in cases where the tumor has been completely resected, possibly due to lymph node (LN) micrometastases. It is estimated that in 10% to 30% of cases, LN micrometastases are not detected by a conventional method for histological assessment of LN metastases with hematoxylin-eosin (HE). A cross-sectional study assessed 51 patients with GC by histological evaluation of the LN micrometastases through LN multi sectioning associated with immunohistochemistry analysis with monoclonal antibodies AE1 and AE3. Total gastrectomy was performed in 51% of patients. The total number of resected LN nodes was 1698, with a mean number of resected LN of 33.3 ± 13.2 per surgical specimen, of which 187 had metastasis. After the application of LN multisection and immunohistochemistry, LN micrometastases were found in 45.1% of the cases. LN staging changed in 29.4%, and tumor staging changed in 23.5% of the cases. In patients initially staged as pN0, LN staging and tumor staging changed, both in 19.2% of the cases. In patients initially staged as pN1 or more, LN staging changed in 40.0% of them, and tumor staging changed in 28.0% of the cases. The accuracy of HE for the histological staging of LN tumoral involvement was 76%, which was considered insufficient for CG patients staging. Investigation of LN micrometastasis through LN multisection and immunohistochemistry should be performed, particularly in cases where the presence of blood and lymphatic vessel invasion has been identified after conventional histological analysis, as well as in patients with advanced Gc. Gastric carcinoma (GC), despite the recent decrease observed in its incidence, remains the second most common cause of cancer death in the world, with more than 600,000 deaths per year. The main chance of cure of this neoplasm is on surgical resection. The standard procedure for the treatment of this condition is radical gastrectomy, which includes gastric resection with surgical margins free of neoplasia, associated with extended locoregional lymphadenectomy 1-3. Accurate tumor staging is one of the leading factors in the definition of the therapeutic strategy. From the exact knowledge of the extent of tumor dissemination, it is possible to define, with greater security, the best therapeutic approach for each patient, and, consequently, avoid incomplete or excessive treatments 4,5. Recent literature has discussed the role of lymph node (LN) micrometastasis in GC. Conceptually, micrometastases are metastases of sizes between 0.2 mm and 2.0 mm (5). Its incidence varies between 10% to 30% 6,7. Currently, many authors admit that its presence is associated with a worse prognosis and that the clinical behavior of these patients is like those with lymph node involvement by metastasis 8. In the submucosal GC (T1b), with the absence of LN metastases and micrometastases, the five-year survival rate is close to 100%, being significantly higher than in micrometastases positive cases (82%) 6. The presence of micrometastasis ma...

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Improved Detection of Metastases by Step Sectioning and Immuno-Histochemical Staining of Axillary Sentinel Nodes in Patients with Breast Carcinoma

Cited by 7 publications

References 29 publications

A Note of Caution

A Note of Caution

Metastasis of Mammary Carcinoma in Bitches: Evaluation of the Sentinel Lymph Node Technique

Impact of multisection and immunohistochemistry in lymph node staging of Gastric Carcinoma – Case series

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