The value of intraoperative frozen section examination of sentinel lymph nodes in surgical management of breast carcinoma

Cipolla, Calogero; Cabibi, Daniela; Fricano, Salvatore; Vieni, Salvatore; Gentile, Irene; Latteri, M

doi:10.1007/s00423-009-0574-9

Cited by 23 publications

(23 citation statements)

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“…Para tumores de hasta 2 cm, el compromiso linfonodal fue significativamente menor que para tumores mayores de 2 cm (22,1% y 47,6%, p = 0,000000008), sin embargo, el porcentaje de detección de metástasis a través de la biopsia intraoperatoria fue similar, lo que difiere de otros estudios [16][17][18] . Al comparar los resultados por el tamaño de las metástasis, encontramos que la sensibilidad para las MA fue significativamente mayor que para las MI y SM (agrupadas) (90,3% y 19,6%, p < 0,0001) lo que ha sido reportado en forma casi constante por otros autores, resaltando el bajo rendimiento del estudio intraoperatorio para la detección de estas últimas.…”

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“…Al comparar los resultados por el tamaño de las metástasis, encontramos que la sensibilidad para las MA fue significativamente mayor que para las MI y SM (agrupadas) (90,3% y 19,6%, p < 0,0001) lo que ha sido reportado en forma casi constante por otros autores, resaltando el bajo rendimiento del estudio intraoperatorio para la detección de estas últimas. Cipolla y cols 16 , en 364 pacientes reportaron una sensibilidad de 74%. La sensibilidad por tamaño tumoral fue de 57,1%, 69,2% y 86,1% respectivamente, para tumores T1a/b, T1c y T2/3, con correlación estadísticamente significativa (p < 0,01).…”

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Rendimiento de la biopsia intraoperatoria por congelación en el estudio del linfonodo centinela en cáncer de mama

et al. 2013

Rev Chil Cir

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Intraoperative frozen section of the sentinel lymph nodes in breast cancerIntroduction: The sentinel lymph node (SN) biopsy has become the standard technique for staging the axillary involvement in breast cancer. The intraoperative diagnosis of lymph node metastatic involvement can immediately decide the need for axillary dissection. The main objective of this study was to determine the accuracy of intraoperative frozen section in the investigation of metastases in the SN, in patients with breast cancer, between 1999 and 2011. Materials and Methods: A retrospective study of patients operated for invasive breast cancer, in which the SN was studied with intraoperative frozen section. Results: 503 patients biopsy was performed with intraoperative frozen section. One hundred fifty-four (30.6%) patients had metastases in the SN, of these 103 (66.9%) were detected on frozen section. No significant difference in the ability to detect metastases for tumors up to 2 cm and tumors more than 2 cm was observed (p = 0.86). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of frozen section for detection of metastases in the SN was 66.9%, 99.7%, 99% and 87%, respectively. Conclusions: The accuracy of intraoperative biopsy for detection of metastases in the SN in our center is comparable to that described in the literature, being effective only for the investigation of macrometastases (MA). Given the low frequency of metastases in the SN in tumors up to 2 cm, associated with a relatively high number of micro (MI) and submicrometastasis (SM) and false negatives, it seems that in these tumors intraoperative biopsy is unnecessary.

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Section: Discussionunclassified

Rendimiento de la biopsia intraoperatoria por congelación en el estudio del linfonodo centinela en cáncer de mama

et al. 2013

Rev Chil Cir

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“…Therefore, FS must be very sensitive to detect metastases and specific to avoid an unnecessary ALND (5) . In this study, we retrospectively analyzed our results of the routine intra-operative FS with the aim to assess its accuracy and sensitivity.…”

Section: Discussionmentioning

confidence: 99%

“…Its purpose is to identify those patients who will benefit from immediate axillary lymph node dissection (ALND) and who will, thus, be spared the expense, inconvenience, and emotional turmoil of a second operation. Therefore, FS must be very sensitive to detect at least macrometastases and be specific to avoid performing an unnecessary ALND (5) . The correlation of intra-operative FS analysis with the final histopathologic diagnosis on permanent section should form an integral part of quality activities in the surgical pathology laboratory (1) .…”

Section: Introductionmentioning

confidence: 99%

Intraoperative frozen section assessment in the evaluation of axillary sentinel lymph node in breast cancer

Thomé¹,

Mendiburu²,

Palma³

et al. 2012

J. Bras. Patol. Med. Lab.

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Introduction:Intraoperative frozen section analysis has become a routine procedure to evaluate the status of axillary sentinel lymph nodes in breast cancer. Objectives: To evaluate the accuracy and sensitivity of FS in the detection of metastases in axillary sentinel lymph nodes and to investigate the predictive value of variables such as patients' age, tumor staging, histology, grade, and estrogen receptor expression. Material and Methods: We analyzed retrospectively the results of 177 FS procedures. The patients' age and tumor characteristics were organized in a database and the association with the presence of metastases was analyzed. Results: Metastases were detected in 22 cases (12%). All macrometastases and one micrometastasis were detected by FS. Additional micrometastases were detected in post-operative analysis, from which five were determined by hematoxylin and eosin staining (H&E) and three by immunohistochemistry (IHC). FS diagnosis data proved to have an overall accuracy of 95%, sensitivity of 64%, and specificity of 100%. None of the analyzed variables showed significant association with lymph node metastases. Conclusion: Our results show that intraoperative FS is a highly accurate and sensitive method to detect macrometastases. However, it is inaccurate in the detection of micrometastases.

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“…In a few cases where the radio-guided surgical probe picked up a weak radiotracer signal, about 10 min before the beginning of surgery, a subareolar injection of 0.5e0.8 ml of vital stain (1% lymphazurin) was performed.in order to further improve the accuracy of the procedure. The excised lymph nodes were then sent to the pathologist, who first performed an intraoperative examination [17], then the definitive one. The result of the histopathological intraoperative examination guided the surgeon in choosing whether or not to complete the surgery with ALND: since macrometastasis were detected in all patients, ALND was performed in all cases.…”

Section: Diagnostic and Therapeutic Procedures And Sln Identificationmentioning

confidence: 99%

Application of a predictive model of axillary lymph node status in patients with sentinel node metastasis from breast cancer. A retrospective cohort study

Vieni

Graceffa

Mendola

et al. 2016

International Journal of Surgery

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h i g h l i g h t sIn about 60% of patients with metatstic SLN, there is no further axillary neoplastic involvement. MSKCC nomogram is a valid tool available to select the patients for axillary lymphadenectomy. The nomogram has a high reliability and a remarkable utility in clinical practice. a r t i c l e i n f o b s t r a c tBackground and objectives: The Axillary Lymph Node Dissection (ALND) is the standard treatment in patients with invasive breast cancer and sentinel node metastasis, but in 60% of the cases there is no further axillary neoplastic involvement, so this invasive intervention represents an overtreatment. The purpose of the study is to identify patients with low risk of additional nodal metastases, to omit ALND. Methods: The MSKCC Additional nodal metastasis nomogram was applied on a sample of 175 patients with invasive breast cancer who underwent ALND after detection of macrometastasis with the extemporaneous examination of the sentinel lymph node. Patients were classified as "low risk" when the result of the nomogram was 50%. Sensitivity, specificity, positive and negative predictive values and AUC (Area Under Curve) of the ROC curve of the nomogram were then calculated. Results: A cut-off by 50% yielded 92.3% sensitivity, 81,4% specificity, 80% positive predictive value and 92.9% negative predictive value. The ROC curve AUC in these patients was 0.885. Conclusions: The MSKCC nomogram has proven to be an effective tool in estimating the axillary lymph node status and it can potentially be used to better select the patients with sentinel node macrometastasis who can actually benefit from ALND.

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The value of intraoperative frozen section examination of sentinel lymph nodes in surgical management of breast carcinoma

Abstract: Intraoperative FS examination of the SLN is a useful predictor of axillary lymph node status in breast cancer patients. The majority of SLN-positive patients allows for immediate ALND in a one-stage surgical procedure.

Cited by 23 publications

References 40 publications

Rendimiento de la biopsia intraoperatoria por congelación en el estudio del linfonodo centinela en cáncer de mama

Rendimiento de la biopsia intraoperatoria por congelación en el estudio del linfonodo centinela en cáncer de mama

Intraoperative frozen section assessment in the evaluation of axillary sentinel lymph node in breast cancer

Application of a predictive model of axillary lymph node status in patients with sentinel node metastasis from breast cancer. A retrospective cohort study

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