Pathological Processing Techniques and Final Diagnosis of Breast Cancer Sentinel Lymph Nodes

Fritzsche, Florian; Reineke, Tanja; Morawietz, Lars; Kristiansen, Glen; Dietel, Manfred; Fink, Daniel; Rageth, Christoph; Honegger, Christoph; Caduff, Rosmarie; Moch, Holger; Varga, Zsuzsanna

doi:10.1245/s10434-010-1097-x

Cited by 14 publications

(5 citation statements)

References 25 publications

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“…Sensitivity of touch imprint cytology is limited by the small amount of tissue investigated, about 50% in the presence of macrometastasis ([2 mm) and 10% for micrometastasis (0.2-2 mm) [2]. Sensitivity is somewhat better with frozen section analysis, but at the cost of tissue loss for paraffin blocks postoperative histopathology [3,4]. In contrast, the molecular techniques allow intraoperative examination of the entire SLN with the same sensitivity as conventional gold-standard postoperative histopathology.…”

Section: Introductionmentioning

confidence: 99%

Sentinel lymph node analysis in breast cancer: contribution of one-step nucleic acid amplification (OSNA)

Godey

Lévèque

Tas

et al. 2011

Breast Cancer Res Treat

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One-step nucleic acid amplification (OSNA, Sysmex, Kobe, Japan) offers an excellent opportunity for accurate exhaustive sentinel lymph node (SLN) examination in breast cancer patients. Calibrated with conventional postoperative histology, this molecular technique yields comparable results intraoperatively, expressed as micrometastasis, macrometastasis or no metastasis depending on the CK19 mRNA copy number amplified in SLN lysates. We applied OSNA to detect metastasis in 810 SLNs from 367 patients with early stage breast cancer. We compared the rate of OSNA-positive SLNs in patients with invasive breast cancer (< 2 cm) versus the rate observed in a historical cohort using conventional histological examination of SLNs. No significant difference was observed, the OSNA assay was positive in 24.4% of patients, compared with positive histology in 24.8% in the historical cohort if including patients with isolated tumour cell (ITC) and in 23.4% excluding them. Opportunities for optimised patient management using OSNA are discussed: intraoperative detection of OSNA-positive SLNs enables axillary lymph node dissection (ALND) during the same procedure; standard OSNA techniques enable the establishment of homogeneous groups based on examination of whole SLNs for valid comparisons between different centres.

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Section: Introductionmentioning

confidence: 99%

Sentinel lymph node analysis in breast cancer: contribution of one-step nucleic acid amplification (OSNA)

Godey

Lévèque

Tas

et al. 2011

Breast Cancer Res Treat

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“…In the present study, the accuracy of diagnosis of intraoperative rapid H&E was very high (91%). To improve the accuracy of intraoperative diagnosis of lymph node metastases, we cut lymph nodes into 2-mm slices and prepared multiple slices (6). However, for breast cancer, the accuracy of intraoperative frozen section diagnosis of metastatic lymph node lesions (metastatic lesions >0.2 mm) varies among studies (1).…”

Section: Discussionmentioning

confidence: 99%

“…However, the accuracy of conventional intraoperative diagnosis remains low. Although the false-negative rate could be reduced by preparing several 2-mm-thick sections, the diagnostic potential of frozen sections is limited (6).…”

Section: Introductionmentioning

confidence: 99%

Advantages of the rapid double-staining method for intraoperative detection of micrometastasis in sentinel lymph nodes

et al. 2013

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For rapid intraoperative diagnosis of lymph node micrometastasis, we refined the rapid immunohistochemistry method by combining anti-cytokeratin antibody-labeled nanocrystal beads with rapid hematoxylin and eosin (H&E) staining on the same section, referred to as the rapid double staining (RDS) technique. Two frozen-section slices each were obtained from 372 lymph nodes of 100 breast cancer patients. We performed RDS for 1 slide and rapid H&E staining for the other. The results were compared with the corresponding final pathological data obtained from the permanent specimens. For specimens from patients with pN1(mi) as determined by final pathological examination, the false‑negative rate was 33.3% for rapid H&E staining and 16.7% for RDS. For specimens from patients with pN0(i+) as determined by final pathological examination, the false‑negative rate was 80% for rapid H&E staining and 0% for RDS. These results indicate that RDS is superior to conventional rapid H&E staining for intraoperative diagnosis of nodal micrometastasis and isolated tumor cells.

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“…Detection of small tumour deposits in lymph nodes is highly dependent on the tissue processing technique . Although the use of frozen sections offers an intraoperative alternative to FFPE, this method is technically difficult and subtle lesions including small metastatic deposits may be difficult to identify . Detection of small clusters of tumour cells present in lymph nodes may not be possible owing to sampling error (Fig.…”

mentioning

confidence: 99%

“…[21][22][23][24] Along with the inherent limited sensitivity of current FFPE-based pathological examination, a major challenge associated with determination of lymph node involvement, with or without the SLN procedure, is the lack of reliable preoperative or intraoperative lymph node metastasis detection methods. 10,16,25 Preoperative lymph node status cannot be reliably predicted because currently available methods such as radiological imaging or fine needle aspiration (FNA) biopsy have major limitations including low sensitivity, particularly in the case of occult tumour deposits. 16,26 Determining the presence of lymph node metastasis before an operation is advantageous as surgery could be preplanned, limited or avoided, resulting in better patient outcome.…”

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confidence: 99%

Beyond conventional pathology: Towards preoperative and intraoperative lymph node staging

Winter

Gibson

Ruszkiewicz

et al. 2014

Intl Journal of Cancer

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Accurate detection of lymph node metastases is critical for many solid tumours to guide treatment strategies and determine prognostic outcomes. The gold standard for detection of metastasis is by histological analysis of formalin-fixed paraffinembedded (FFPE) sections of removed lymph nodes; this analysis method has remained largely unchanged for decades. Recent studies have highlighted limitations in the sensitivity of this approach, at least in its current clinical use, to detect very small metastatic deposits. Importantly, the poor prognostic outcomes associated with the presence of such small tumour deposits are now well established in a number of cancers. In addition, histological analysis of FFPE sections cannot be used practically for intraoperative node assessment. Novel lymph node staging technologies are therefore actively being developed. This review critically presents the main advances in this field and discusses why these technologies have not been able to provide a better alternative to the current gold standard diagnostic technique.Localized spread of cancer cells to lymph nodes has been established as one of the most significant prognostic indicators, and consequently its identification is of the highest importance in clinical oncology and a key element of solid tumour staging. The gold standard for the detection of lymphatic involvement is the postoperative examination of formalin-fixed paraffin-embedded (FFPE) sections of the resected lymph nodes. However, recent studies have shown limitations of this technique's sensitivity to detect occult tumour deposits in lymph nodes.

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Pathological Processing Techniques and Final Diagnosis of Breast Cancer Sentinel Lymph Nodes

Abstract: SynopsisComparison of breast cancer sentinel lymph node processing protocols. Type and extent of intra-and postoperative pathological work-up respectively affects the accuracy of sentinel lymph node biopsies in terms of pN-status and detection of isolated tumor cells.

Cited by 14 publications

References 25 publications

Sentinel lymph node analysis in breast cancer: contribution of one-step nucleic acid amplification (OSNA)

Sentinel lymph node analysis in breast cancer: contribution of one-step nucleic acid amplification (OSNA)

Advantages of the rapid double-staining method for intraoperative detection of micrometastasis in sentinel lymph nodes

Beyond conventional pathology: Towards preoperative and intraoperative lymph node staging

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