The diagnostic accuracy of intraoperative frozen section biopsy for diagnosis of sentinel lymph node metastasis in breast cancer patients: a meta-analysis

Abstract

Sentinel lymph node (SLN) sampling is important for evaluating the nodal stage of breast cancer when the axillary nodes are clinically free of metastasis. The intraoperative frozen section (IFS) of SLN is used for lymph node assessment. This meta-analysis aims to provide evidence about the diagnostic accuracy and the applicability of IFS of SLN in breast cancer patients. Data were collected by searching PubMed, Cochrane, Scopus, and Web of Science electronic databases for trials matching our eligibility criteria. The statistical analysis included the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and pooled studies’ diagnostic odds ratio outcomes. The analyses were conducted using the Open Meta-analyst software. This meta-analysis pooled the results of 110 studies. The overall sensitivity of IFS for SLN metastasis was 74.7%; 95% CI [72.0, 77.2], P < 0.001. It was 31.4% 95% CI [25.2, 38.3], P < 0.001 for the micro-metastasis, and 90.2%; 95% CI [86.5, 93.0], P < 0.001 for the macro-metastasis. The overall specificity was 99.4%; 95% CI [99.2, 99.6], P < 0.001. The overall positive likelihood ratio was 121.4; 95% CI [87.9, 167.6], P < 0.001, and the overall negative likelihood ratio was 0.226; 95% CI [0.186, 0.274], P < 0.001. The overall diagnostic odds ratio of IFS for diagnosing SLN metastasis was 569.5; 95% CI [404.2, 802.4], P < 0.001. The intraoperative frozen section of SLN has good sensitivity for diagnosing breast cancer macro-metastasis. However, the sensitivity is low for micro-metastasis. The specificity is very satisfactory.

Frozen section telepathology service: Efficiency and benefits of an e-health policy in South Tyrol

“…This is in line with literature on the topic, highlighting that FS itself has very good diagnostic performance concerning detection of macrometastases, but inferior sensitivity in detection of micrometastases and isolated tumor cells. 43 , 44 False-negative rates range in international studies between 5% to 43% and also in large centers is comparable to ours. 45 The potential negative consequence of a false-negative FS diagnosis of a sentinel node should be evaluated is not that severe, considering that the indications for axillary dissection have changed over time.…”

Predicting Factors Affecting Lymph Node Involvement in Breast Cancer Using Random Forest Approaches

“…influence on cancer recurrence and survival (4). Furthermore, axillary lymph node metastasis is a critical determinant in treatment decision-making and prognosis (5).…”