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Sentinel lymph node biopsy in breast cancer: the role of micrometastasis

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Abstract

Intraoperative sentinel lymph node biopsy is widely used in patients with early-stage breast cancer for staging the axilla. The conventional analysis of the SLN has classically been performed by frozen section or touch imprint with a rapid H&E (hematoxylin and eosin) staining. Because of the risk of false-negative results, it has been replaced by the one-step acid amplification (OSNA) assay, a molecular diagnostic assay for the detection of cytokeratin 19 mRNA expression. Due to the controversial for the use of OSNA to evaluate the SLN because of its cost-effective and the lack of consensus to perform or avoid a lymphadenectomy when there is micrometastasis, we analyze 410 patients subjected to SLN biopsy in Hospital Puerta de Hierro, Madrid (Spain). Of the total of nodes, 223 (54.4 %) were processed throughout frozen-section examination and imprint cytology and 187 (45.6 %) throughout OSNA. The specificity of the frozen-section histological examination was of 100 %, with a sensitivity of 83.33 % (95 % CI 73.07–93.60). Of the 40 patients with definitive micrometastasis in the SLN, axillary dissection was performed in 90 % of the patients, with subsequent positive affectation in four of them (11.11 %). Based on our result and taking into account that 10 % of the lymphadenectomy performed after micrometastasis are positive, we do not believe that lymphadenectomy should be avoided after N(mi+) is detected in a SLN.

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Conflict of interest

All authors declare that they do not have potential conflicts of interest.

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Authors and Affiliations

  1. Medical Oncology Service, Hospital Universitario Puerta de Hierro Majadahonda, Calle Manuel de Falla, 1, 28222, Madrid, Spain

    David Pérez-Callejo, Fernando Franco, Beatriz Núñez, Blanca Cantos & Mariano Provencio

  2. Anatomical Pathology Service, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

    Carmen González-Lois

Authors
  1. David Pérez-Callejo
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  2. Fernando Franco
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  3. Beatriz Núñez
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  4. Carmen González-Lois
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  5. Blanca Cantos
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  6. Mariano Provencio
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Correspondence to Mariano Provencio.

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Pérez-Callejo, D., Franco, F., Núñez, B. et al. Sentinel lymph node biopsy in breast cancer: the role of micrometastasis. Med Oncol 32, 36 (2015). https://doi.org/10.1007/s12032-014-0450-5

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