Intraoperative Touch Imprint and Frozen Section Analysis of Sentinel Lymph Nodes After Neoadjuvant Chemotherapy for Breast Cancer

Komenaka, Ian K.; Torabi, Radmehr; Nair, Geetha R.; Jayaram, Lakshmi; Hsu, Chiu Hsieh; Bouton, Marcia E.; Dave, Hitendu; Hobohm, Dan

doi:10.1097/sla.0b013e3181ba845c

Cited by 33 publications

(20 citation statements)

References 15 publications

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“…[29][30][31] Although there was a concern that NAC-induced histological changes of metastases and lymph nodes such as fi brosis, fat necrosis, histiocytic accumulation, and granulation tissue formation may interfere with the detection of metastases, our results were comparable with those obtained in early untreated breast cancer. We compared the results of intraoperative frozen-section (FS) analysis in patients treated with NAC and those not treated with NAC.…”

Section: Intraoperative Assessment Of Sentinel Lymph Nodes After Neoasupporting

confidence: 83%

Sentinel lymph node biopsy before versus after neoadjuvant chemotherapy for breast cancer

Shimazu

Noguchi

2011

Surg Today

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Axillary lymph node status is the most important prognostic factor in the treatment of breast cancer. In recent years, sentinel lymph node biopsy (SLNB) has replaced conventional axillary lymph node dissection for predicting axillary lymph node status with higher accuracy. Moreover, neoadjuvant chemotherapy (NAC) is being used increasingly to treat not only patients with locally advanced inoperative breast cancer, but also those with initially operable breast cancer. The application of SLNB has now expanded to include this patient population, who were not previously considered good candidates for SLNB. A number of recent studies have evaluated the feasibility and accuracy of SLNB after NAC in breast cancer patients. Moreover, SLNB has been shown to be accurate in patients scheduled to receive NAC, and repeat SLNB has been performed after NAC for patients with positive nodes detected by the initial SLNB before NAC. Thus, the optimal timing of SLNB for patients with breast cancer in the neoadjuvant setting remains controversial. This article reviews the issues surrounding SLNB before vs. after NAC, according to the published literature and our experience.

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Section: Intraoperative Assessment Of Sentinel Lymph Nodes After Neoasupporting

confidence: 83%

Sentinel lymph node biopsy before versus after neoadjuvant chemotherapy for breast cancer

Shimazu

Noguchi

2011

Surg Today

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“…These figures compare favourably with those for the cases examined with Genesearch in this study (retrospective samples) and in published data . This contrasts with established methods used in the intraoperative setting: FS and DAB cytology . A meta‐analysis of the published literature has indicated that FS analysis has a sensitivity of 76% and that imprint cytology has a sensitivity of 62%, with marked divergence in the range of sensitivities and specificities reported.…”

Section: Discussioncontrasting

confidence: 47%

“…These methodologies have limitations in the context of one‐step axillary clearance. Conventional histopathology has the disadvantage of a delayed time course of 2–3 days, and FS and DABc, although highly specific, have inherent sensitivity issues . The molecular approach has the disadvantages of cost and disruption resulting from the implementation of a new technology, but it offers the advantages of enhanced sensitivity and specificity.…”

Section: Introductionmentioning

confidence: 99%

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A multicentre validation of Metasin: a molecular assay for the intraoperative assessment of sentinel lymph nodes from breast cancer patients

et al. 2016

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Aims: Treatment strategies for breast cancer continue to evolve. No uniformity exists in the UK for the management of node-positive breast cancer patients. Most centres continue to use conventional histopathology of sampled sentinel lymph nodes (SLNs), which requires delayed axillary clearance in up to 25% of patients. Some use touch imprint cytology or frozen section for intraoperative testing, although both have inherent sensitivity issues. An intraoperative molecular diagnostic approach helps to overcome some of these limitations. The aim of this study was to assess the clinical effectiveness of Metasin, a molecular method for the intraoperative evaluation of SLNs. Methods and results: RNA from 3296 lymph nodes from 1836 patients undergoing SLN assessment was analysed with Metasin. Alternate slices of tissue were examined in parallel by histology. Cases deemed to be discordant were analysed by protein gel electrophoresis. There was concordance between Metasin and histology in 94.1% of cases, with a sensitivity of 92% [95% confidence interval (CI) 88-94%] and a specificity of 97% (95% CI 2016 , 68, 875-887. DOI: 10.1111 95-97%). Positive and negative predictive values were 88% and 98%, respectively. Over half of the discordant cases (4.4%) were ascribed to tissue allocation bias (TAB).Conclusions: Clinical validation of the Metasin assay suggests that it is sufficiently sensitive and specific to make it fit for purpose in the intraoperative setting.

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“…The sentinel node procedure at our institution has been described previously [23]. In brief, the sentinel node procedure was performed using the combination technique of blue dye and radioactive isotope.…”

Section: Surgical Outcomesmentioning

confidence: 99%

Preoperative Chemotherapy for Operable Breast Cancer Improves Surgical Outcomes in the Community Hospital Setting

et al. 2011

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Intraoperative Touch Imprint and Frozen Section Analysis of Sentinel Lymph Nodes After Neoadjuvant Chemotherapy for Breast Cancer

Cited by 33 publications

References 15 publications

Sentinel lymph node biopsy before versus after neoadjuvant chemotherapy for breast cancer

Sentinel lymph node biopsy before versus after neoadjuvant chemotherapy for breast cancer

A multicentre validation of Metasin: a molecular assay for the intraoperative assessment of sentinel lymph nodes from breast cancer patients

Preoperative Chemotherapy for Operable Breast Cancer Improves Surgical Outcomes in the Community Hospital Setting

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