Is sentinel lymph node biopsy without frozen section in early stage breast cancer sufficient in accordance with ACOSOG-Z0011? A retrospective review from King Chulalongkorn Memorial Hospital.

Abstract

Background: In 2021, increased implementation of the usage of permanent section (PS) without intraoperative frozen section (FS) for sentinel lymph node biopsy (SLNB) were evident worldwide. This pilot study conducted in Thailand will determine the re-operation rate in SLNB without FS technique. Method: we retrospectively reviewed 239 cases of SLNB without FS in King Chulalongkorn Memorial Hospital from April 2016 to April 2021. These patients were diagnosed with primary invasive breast cancer with clinical node negative. The clinical nodal status was assessed from physical examination. The re-operation rate was evaluated by the number of positive SLNs; equal or more than 3 nodal metastases were subjected to second surgical procedure. Result: Between April 2016 and April 2021, there are 239 patient who had undergone SLNB in accordance with ACOSOG Z0011 criteria with the use of PS alone. A total of 975 SLNs were removed from these 239 patients, with an average of 4.15 nodes per patient. Out of 239 patients, 21 (8.8%) and 6 (2.5%) had metastatic disease in 1 and 2 nodes, respectively. The remaining 212 (88.7%) patients had no nodal metastasis. None of the patients were subjected to a second surgical procedure.Conclusion: With a re-operation rate of 0%, we concluded that the implementation of SLNB with PS analysis alone in patients who satisfied the ACOSOG Z0011 criteria do not altered the standard of care offered by additional FS analysis. With cessation of intraoperative procedure, operation cost, operation time and anesthetic side effect are projected to decrease.

Is Routine Intraoperative Frozen Section Analysis of Sentinel Lymph Nodes Necessary in Every Early-Stage Breast Cancer?

“…Additional iFS would not alter any standard of care in patients who fulfill the ACOSOG classification. 28 An Iranian study reinforced that low tumor burdens were detected from FS in early-stage breast cancer patients. 29 From a total of 214 cases analyzed in this 6-year retrospective review, 5 cases were found with more than two metastatic nodes which was an indication for further ALND in accordance with the Z0011 trial.…”