Use of intraoperative stereomicroscopy for preventing loss of metastases during frozen sectioning of sentinel lymph nodes in breast cancer

Varga, Zsuzsanna; Rageth, Christoph; Saurenmann, Elisabeth; Honegger, Christoph; Orelli, Stephanie von; Fehr, Mathias K.; Fink, Daniel; Seifert, Burkhardt; Moch, H.; Caduff, Rosmarie

doi:10.1111/j.1365-2559.2008.02998.x

Cited by 8 publications

(11 citation statements)

References 28 publications

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“…Importantly, our findings suggest that a higher intraoperative detection rate for metastases with more than one IFS was also accompanied by a significantly lower rate of metastases in the final diagnosis. This supports the hypothesis that tissue loss occurs during the procedure of IFS [9], which might have been one reason for recommendations in the United Kingdom of not performing IFS [12]. To avoid tissue loss was also the basic concept for using stereomicroscopic preselection of SLN for IFS as described by Varga et al [9].…”

Section: Discussionsupporting

confidence: 60%

“…SLN from these patients were processed as follows (Table 1): Axillary SLN were longitudinally bisected (or sectioned in 2 mm slices in SLN larger than 5 mm) and primarily assessed with a stereomicroscope. If the cut surface of the lymph node was clearly involved by the tumor or highly suspicious for malignancy, one single frozen section of the lymph node was performed [9]. In all other cases, lymph nodes were submitted to paraffin embedding and complete histological sectioning: paraffin blocks were completely …”

Section: Study Cohorts and Protocolsmentioning

confidence: 99%

“…Intraoperative sentinel lymph node (SLN) biopsy is a good predictor of the axillary nodal status and is now a standard method in the assessment of patients with early breast cancer [3][4][5][6]. Despite the general acceptance of the SLN model, protocols for intra-and postoperative processing of SLN differ widely [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…The Swiss Section of Gynecological Pathologists has recommended an approach of one single IFS followed by complete postoperative step-sectioning using 200 µm intervals. Varga et al have recently proposed the use of a stereomicroscope for the intraoperative assessment of SLN and preselection for IFS [9]. Stereomicroscopy consists of the examination of native unstained tissue samples with a magnification factor between 6 and 40, avoiding potential tissue loss associated with IFS of SLN [9].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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Section: Discussionsupporting

confidence: 60%

Section: Study Cohorts and Protocolsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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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: 97%

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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Frozen section analysis of sentinel lymph nodes in patients with breast cancer does not impair the probability to detect lymph node metastases

et al. 2011

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Intra-operative frozen section analysis (FS analysis) of sentinel lymph nodes (SLNs) in patients with breast cancer can prevent a second operation for axillary lymph node dissection. In contrast, loss of tissue during FS analysis may impair the probability to detect lymph node metastases. To determine the effect of tissue loss on the probability of detection of metastases, dimensions and tissue loss resulting from intra-operative frozen section analysis were measured for 21 SLNs. In a mathematical model, the influence of tissue loss on the probability to detect metastases was calculated in relation to SLN size for various pathology protocols: an American, a widely used European, the extensive ‘Milan’ and the Dutch protocol. For median-sized SLN 11 × 8 × 5 mm (length × width × height), FS analysis led to a median loss of 680 μm (13.6%) of the height of the SLN. Irrespective of SLN size or used pathology protocol, the probability of detecting 2 mm metastases remained unchanged or even increased (0–12.8%). Moreover, the probability to detect 0.2 mm metastases increased for the majority of tested combinations of SLN size, tissue loss and used protocol. Only when combining maximum tissue loss and smallest SLN size in the Dutch protocol, or when applying the extensive Milan protocol on a median-sized SLN, the probability to detect 0.2 mm metastases decreased by 2.7% and 14.3%, respectively. Contrary to ‘common knowledge’, doing FS analysis of SLNs does not impair the probability to detect lymph node metastases.

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Use of intraoperative stereomicroscopy for preventing loss of metastases during frozen sectioning of sentinel lymph nodes in breast cancer

Abstract: Frozen sections potentially lead to loss or reduced size of metastatic deposits in SLN. Avoiding intraoperative frozen sections on grossly inconspicuous SLN may therefore be justified.

Cited by 8 publications

References 28 publications

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

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

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

Frozen section analysis of sentinel lymph nodes in patients with breast cancer does not impair the probability to detect lymph node metastases

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