Elsevier

Surgery

Volume 135, Issue 3, March 2004, Pages 248-254
Surgery

Original communication
Thorough intraoperative analysis of breast sentinel lymph node biopsies: histologic and immunohistochemical findings

https://doi.org/10.1016/j.surg.2003.10.002Get rights and content

Abstract

Background

We report the use of a thorough intraoperative sentinel lymph node (SLN) biopsy screening procedure for patients with small N0 breast tumors.

Methods

Sixty-eight consecutive female patients with monofocal stage I or “small” stage II (ie, 2.1-3.0 cm) N0 tumors received intraoperative SLN screening according to a procedure on the basis of comprehensive histologic analysis and cytokeratin immunohistochemical determination (CkID) of adjacent frozen sections of the SLN taken at 50-μm cutting levels.

Results

The maximum duration of intraoperative analysis including CkID was 40 minutes. Positive SLN were found in 15/68 (22%) patients (always in a single node); they included 5 instances of micrometastasis and 3 of carcinomatous lymphangitis. In the 14 patients who underwent axillary lymph node dissection, no further metastasis was found at histologic analysis or CkID. SLN positivity correlated with histologic type (P = .044), intratumoral or peritumoral vascular invasion (P<.001) and Mib1 score (P = .042).

Conclusions

It is possible for an experienced team to perform intraoperative SLN screening for T1 or small T2 N0 breast tumors with frozen sections taken at 50-μm cutting levels. This procedure facilitates identification of micrometastasis, as well as of carcinomatous lymphangitis to help understand the biologic implications of these small lesions in the long term. SLN positivity appears to correlate with histologic type, intratumoral/peritumoral vascular invasion and Mib1 score.

Section snippets

Patients and SLN identification

Between January 1998 and January 2002, 68 female patients (median age 55 years, range 33 to 78 years) with unifocal, clinically/radiologically node-negative primary breast cancer received surgical treatment with SLN biopsy (performed by A.G.) and intraoperative pathologic examination (by W.F.G. and A.D.). The single enrollment criterion for the SLN biopsy procedure was presence of a unifocal T1 (≤2.0 cm in diameter) or small T2 (ie, 2.1 to 3.0 cm) primary breast tumor without clinical evidence

Results

Among the 68 primary tumors (median size 1.2 cm, range 0.4-2.8 cm), 6 (9%) were classified as pT1a (ie, ≤0.5 cm), 19 (28%) as pT1b (0.6 to 1.0 cm), 38 (56%) as pT1c (1.1 to 2.0 cm), and 5 (7%) as “small” pT2 (defined for the purposes of this study as 2.1 to 3.0 cm) (Table I). A single SLN was identified in 61 of 68 (90%) patients, 2 were taken in 3 (4%) patients, 3 were taken in 3 (4%) patients; and in 1 (2%) patient, 5 small radioactive nodes were taken. The maximum time taken for

Discussion

Among the methods for intraoperative evaluation of SLN in patients with small breast tumors described in the literature, the procedure proposed by Viale et al12 and Veronesi et al20 on frozen material appears to be especially reliable, with a general concordance between sentinel and axillary lymph node status of over 95%. Nevertheless, to our knowledge, reports of routine use of such an approach in other hands are currently lacking. Furthermore, according to the ADASP recommendations,22

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