INTRA OPERATIVE FROZEN EXAMINATION OF SENTINEL LYMPH NODE IN BREAST CANCER

Authors

  • Lubna Mushtaque Vohra
  • Rubina Gulzar
  • Omema Saleem

Abstract

Background: Sentinel node (SN) biopsy is the standard of care for the assessment of axilla in early breast cancer patients with clinically node negative disease. Confirmed absence of tumour deposit in node on intra operative frozen section (FS) examination saves the patient from complete axillary dissection. However controversies arise when inconsistencies occur in results of frozen and permanent section. Reported sensitivity of frozen examination of sentinel node in literature ranges from 70–95%.The purpose of this study was to determine the sensitivity of frozen examination of sentinel node in breast cancer. The frozen section examination of sentinel node is not a reliable technique for accurate pathological assessment of node. Methods: Data was collected prospectively on patients with sentinel node procedure from May to December 2013. All SNs removed at surgery were submitted for frozen section and the results were compared with permanent sections. Results: Of 50 patients 16 were true positive while 32 were true negative. Two patients reported negative on FS were confirmed to be positive on permanent section. The accuracy of frozen section was 96%, with sensitivity of 89%. In false negative cases the size of nodal metastasis was significantly smaller than that of true positive, i.e., 1–2 mm. The false negative cases were further classified for assessment into technical and interpretative error. Conclusion: The intra operative frozen section examination is a reliable technique for the assessment of Sentinel node with a high accuracy rate to detect metastasis size of ≥2mm. It spares the patient from complete axillary dissection and its subsequent morbidity of lymphedema and shoulder pain.Keywords: Sentinel node, frozen section, Breast cancer.

References

Veronesi U, Viale G, Paganelli G, Zurrida S, Luini A, Galimberti V, et al. Sentinel Lymph node biopsy in breast cancer: ten-year results of a randomized Controlled study. Ann Surg 2010;251(4):595–600.

Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003;349(6):546–53.

Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 2010;11(10):927–33.

Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg 2010;252(3):426–32.

Veronesi U, Zurrida S, Mazzarol G, Viale G .Extensive frozen section examination of axillary sentinel nodes to determine selective axillary dissection. World J Surg 2001;25(6):806–8.

Viale G, Bosari S, Mazzarol G, Galimberti V, Luini A, Veronesi P, et al. Intraoperative examination of axillary sentinel lymph nodes in breast carcinoma patients. Cancer 1999;85(11):2433–8.

Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol 2006;7(12):983–90.

Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol 2007;8(10):881–8

Zavagno G, De Salvo GL, Scalco G, Bozza F, Barutta L, Del Bianco P, et al. A Randomized clinical trial on sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer: results of the Sentinella/GIVOM trial. Ann Surg 2008;247(2):207–13.

Viale G, Maiorano E, Pruneri G, Mastropasqua MG, Valentini S, Galimberti V, et al. Predicting the risk for additional axillary metastases in patients with breast carcinoma and positive sentinel lymph node biopsy. Ann Surg 2005;241(2):319–25.

Albertini JJ, Lyman GH, Cox C, Yeatman T, Balducci L, Ku N, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 1996;276(22):1818–22.

Langer I, Guller U, Viehl CT, Moch H, Wight E, Harder F, et al. Axillary lymph node dissection for sentinel lymph node micrometastases may be safely omitted in early-stage breast cancer patients: long-term outcomes of a prospective study. Ann Surg Oncol 2009;16(12):3366–74.

Reed J, Rosman M, Verbanac KM, Mannie A, Cheng Z, Tafra L. Prognostic implications of isolated tumor cells and micrometastases in sentinel nodes of patients with invasive breast cancer: 10-year analysis of patients enrolled in the prospective East Carolina University/Anne Arundel Medical Center Sentinel Node Multicenter Study. J Am Coll Surg 2009;208(3):333–40

Cserni G, Amendoeira I, Apostolikas N, Bellocq JP, Bianchi S, Boecker W, et al. Discrepancies in current practice of pathological evaluation of sentinel lymph nodes in breast cancer. Results of a questionnaire based survey by the European Working Group for Breast Screening Pathology. J Clin Pathol 2004;57(7):695–701.

Cserni G, Amendoeira I, Apostolikas N, Bellocq JP, Bianchi S, Bussolati G, et al. Pathological work-up of sentinel lymph nodes in breast cancer. Review of current data to be considered for the formulation of guidelines. Eur J Cancer 2003;39(12):1654–67.

Cserni G. Histopathologic examination of the sentinel lymph nodes. Breast J 2006;12(5 Suppl 2):S152–6.

Motomura K, Inaji H, Komoike Y, Kasugai T, Nagumo S, Noguchi S, et al. Intraoperative sentinel lymph node examination by imprint cytology and frozen sectioning during breast surgery. Br J Surg 2000;87(5):597–601

Upender S, Mohan H, Handa U, Attri AK. Intraoperative evaluation of sentinel lymph nodes in breast carcinoma by imprint cytology, frozen section and rapid immunohistochemistry. Diagn Cytopathol. 2009;37(12):871–5.

Schwartz GF, Krill LS, Palazzo JP, Dasgupta A. Value of intraoperative examination of axillary sentinel nodes in carcinoma of the breast. J Am Coll Surg. 2008;207(5):758–62.

Wada N, Imoto S, Hasebe T, Ochiai A, Ebihara S, Moriyama N. Evaluation of intraoperative frozen section diagnosis of sentinel lymph nodes in breast cancer. Jpn J Clin Oncol. 2004;34(3):113–7.

van de Vrande S, Meijer J, Rijnders A, Klinkenbijl JH. The value of intraoperative frozen section examination of sentinel lymph nodes in breast cancer. Eur J Surg Oncol 2009;35(3):276–80

Cipolla C, Cabibi D, Fricano S, Vieni S, Gentile I, Latteri MA. The value of intraoperative frozen section examination of sentinel lymph nodes in surgical management of breast carcinoma. Langenbecks Arch Surg 2009 2010;395(6):685–91.

Krishnamurthy S, Meric-Bernstam F, Lucci A, Hwang RF, Kuerer HM, Babiera G, et al. A prospective study comparing touch imprint cytology, frozen section analysis, and rapid cytokeratin immunostain for intraoperative evaluation of axillary sentinel lymph nodes in breast cancer. Cancer 2009;115(7):1555–62.Chan SW, LaVigne KA, Port ER, Fey JV, Brogi E, Borgen PI, et al. Does the benefit of sentinel node frozen section vary between patients with invasive duct, invasive lobular, and favorable histologic subtypes of breast cancer?. Ann Surg 2008;247(1):143–9.

Horvath JW, Barnett GE, Jimenez RE, Young DC, Povoski SP. Comparison of intraoperative frozen section analysis for sentinel lymph node biopsy during breast cancer surgery for invasive lobular carcinoma and invasive ductal carcinoma. World J Surg Oncol 2009;7:34.

Ali R, Hanly AM, Naughton P, Castineira CF, Landers R, Cahill RA, Watson RG. Intraoperative frozen section assessment of sentinel lymph nodes in the operative management of women with symptomatic breast cancer. World J Surg Oncol 2008;6:69.

Arlicot C, Louarn AL, Arbion F, Leveque J, Lorand S, Kinn J, et al. Evaluation of the two intraoperative examination method for sentinel lymph node assessment: a multi centric and retrospective study on more than 2,000 nodes. Anticancer Res 2013;33(3):1045–52

Veronesi U, Viale G, Paganelli G, Zurrida S, Luini A, Galimberti V, et al. Sentinel Lymph node biopsy in breast cancer: ten-year results of a randomized Controlled study. Ann Surg 2010;251(4):595–600.

Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003;349(6):546–53.

Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 2010;11(10):927–33.

Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg 2010;252(3):426–32.

Veronesi U, Zurrida S, Mazzarol G, Viale G .Extensive frozen section examination of axillary sentinel nodes to determine selective axillary dissection. World J Surg 2001;25(6):806–8.

Viale G, Bosari S, Mazzarol G, Galimberti V, Luini A, Veronesi P, et al. Intraoperative examination of axillary sentinel lymph nodes in breast carcinoma patients. Cancer 1999;85(11):2433–8.

Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol 2006;7(12):983–90.

Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol 2007;8(10):881–8

Zavagno G, De Salvo GL, Scalco G, Bozza F, Barutta L, Del Bianco P, et al. A Randomized clinical trial on sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer: results of the Sentinella/GIVOM trial. Ann Surg 2008;247(2):207–13.

Viale G, Maiorano E, Pruneri G, Mastropasqua MG, Valentini S, Galimberti V, et al. Predicting the risk for additional axillary metastases in patients with breast carcinoma and positive sentinel lymph node biopsy. Ann Surg 2005;241(2):319–25.

Albertini JJ, Lyman GH, Cox C, Yeatman T, Balducci L, Ku N, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 1996;276(22):1818–22.

Langer I, Guller U, Viehl CT, Moch H, Wight E, Harder F, et al. Axillary lymph node dissection for sentinel lymph node micrometastases may be safely omitted in early-stage breast cancer patients: long-term outcomes of a prospective study. Ann Surg Oncol 2009;16(12):3366–74.

Reed J, Rosman M, Verbanac KM, Mannie A, Cheng Z, Tafra L. Prognostic implications of isolated tumor cells and micrometastases in sentinel nodes of patients with invasive breast cancer: 10-year analysis of patients enrolled in the prospective East Carolina University/Anne Arundel Medical Center Sentinel Node Multicenter Study. J Am Coll Surg 2009;208(3):333–40

Cserni G, Amendoeira I, Apostolikas N, Bellocq JP, Bianchi S, Boecker W, et al. Discrepancies in current practice of pathological evaluation of sentinel lymph nodes in breast cancer. Results of a questionnaire based survey by the European Working Group for Breast Screening Pathology. J Clin Pathol 2004;57(7):695–701.

Cserni G, Amendoeira I, Apostolikas N, Bellocq JP, Bianchi S, Bussolati G, et al. Pathological work-up of sentinel lymph nodes in breast cancer. Review of current data to be considered for the formulation of guidelines. Eur J Cancer 2003;39(12):1654–67.

Cserni G. Histopathologic examination of the sentinel lymph nodes. Breast J 2006;12(5 Suppl 2):S152–6.

Motomura K, Inaji H, Komoike Y, Kasugai T, Nagumo S, Noguchi S, et al. Intraoperative sentinel lymph node examination by imprint cytology and frozen sectioning during breast surgery. Br J Surg 2000;87(5):597–601

Upender S, Mohan H, Handa U, Attri AK. Intraoperative evaluation of sentinel lymph nodes in breast carcinoma by imprint cytology, frozen section and rapid immunohistochemistry. Diagn Cytopathol. 2009;37(12):871–5.

Schwartz GF, Krill LS, Palazzo JP, Dasgupta A. Value of intraoperative examination of axillary sentinel nodes in carcinoma of the breast. J Am Coll Surg. 2008;207(5):758–62.

Wada N, Imoto S, Hasebe T, Ochiai A, Ebihara S, Moriyama N. Evaluation of intraoperative frozen section diagnosis of sentinel lymph nodes in breast cancer. Jpn J Clin Oncol. 2004;34(3):113–7.

van de Vrande S, Meijer J, Rijnders A, Klinkenbijl JH. The value of intraoperative frozen section examination of sentinel lymph nodes in breast cancer. Eur J Surg Oncol 2009;35(3):276–80

Cipolla C, Cabibi D, Fricano S, Vieni S, Gentile I, Latteri MA. The value of intraoperative frozen section examination of sentinel lymph nodes in surgical management of breast carcinoma. Langenbecks Arch Surg 2009 2010;395(6):685–91.

Krishnamurthy S, Meric-Bernstam F, Lucci A, Hwang RF, Kuerer HM, Babiera G, et al. A prospective study comparing touch imprint cytology, frozen section analysis, and rapid cytokeratin immunostain for intraoperative evaluation of axillary sentinel lymph nodes in breast cancer. Cancer 2009;115(7):1555–62.Chan SW, LaVigne KA, Port ER, Fey JV, Brogi E, Borgen PI, et al. Does the benefit of sentinel node frozen section vary between patients with invasive duct, invasive lobular, and favorable histologic subtypes of breast cancer?. Ann Surg 2008;247(1):143–9.

Horvath JW, Barnett GE, Jimenez RE, Young DC, Povoski SP. Comparison of intraoperative frozen section analysis for sentinel lymph node biopsy during breast cancer surgery for invasive lobular carcinoma and invasive ductal carcinoma. World J Surg Oncol 2009;7:34.

Ali R, Hanly AM, Naughton P, Castineira CF, Landers R, Cahill RA, Watson RG. Intraoperative frozen section assessment of sentinel lymph nodes in the operative management of women with symptomatic breast cancer. World J Surg Oncol 2008;6:69.

Arlicot C, Louarn AL, Arbion F, Leveque J, Lorand S, Kinn J, et al. Evaluation of the two intraoperative examination method for sentinel lymph node assessment: a multi centric and retrospective study on more than 2,000 nodes. Anticancer Res 2013;33(3):1045–52

Published

2015-03-01