Annals of Surgical Oncology

, Volume 8, Issue 4, pp 361–367 | Cite as

Intraoperative Pathologic Evaluation of a Breast Cancer Sentinel Lymph Node Biopsy as a Determinant for Synchronous Axillary Lymph Node Dissection

  • John M. KaneIII
  • Stephen B. Edge
  • Janet S. Winston
  • Nancy Watroba
  • Thelma C. Hurd
Original Articles


Background: Intraoperative pathologic evaluation of a breast cancer sentinel lymph node (SLN) biopsy permits synchronous axillary lymph node dissection (ALND), but frozen section is time consuming and potentially inaccurate. This study evaluated intraoperative gross examination and touch prep analysis (TPA) of a breast cancer SLN biopsy as determinants for synchronous ALND.

Methods: Intraoperative gross examination/TPA were performed on the SLN of consecutive breast cancer patients from 1997 to 2000. Patients with an intraoperative “positive” SLN underwent synchronous ALND. Intraoperative results were compared with the final pathology.

Results: Thirty-seven of 150 patients had a positive SLN on final pathology. Intraoperative gross examination/TPA identified 54% (20 of 37) of these patients. All intraoperative “positive” patients underwent synchronous ALND. Of 17 “false-negative” findings, 53% (9 of 17) had micrometastatic disease. There were no “false-positive” results. Overall sensitivity and specificity were 54% and 100%, respectively.

Conclusions: Gross examination/TPA are simple, rapid techniques for the intraoperative evaluation of a breast cancer SLN. As there were no false-positive results, the rationale behind SLN biopsy was preserved. These techniques permitted synchronous ALND in over half of all patients with a positive SLN. This represents a potential benefit to the patient by eliminating a second hospitalization for delayed ALND.

Key Words:

Breast cancer Sentinel lymph node Touch prep analysis Intraoperative evaluation 


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  1. 1.
    Recht A, Houlihan MJ. Axillary lymph nodes and breast cancer. Cancer 1995; 76: 1491–512.Google Scholar
  2. 2.
    Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 1993; 2: 335–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994; 220: 391–401.PubMedGoogle Scholar
  4. 4.
    Giuliano AE, Dale PS, Turner RT, Morton DL, Evans SW, Krasne DL. Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg 1995; 222: 394–401.Google Scholar
  5. 5.
    Barnwell JM, Arredondo MA, Kollmorgen D, et al. Sentinel node biopsy in breast cancer. Ann Surg Oncol 1998; 5: 126–30.Google Scholar
  6. 6.
    Veronesi U, Paganelli G, Galimberti V, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 1997; 349: 1864–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Flett MM, Going JJ, Stanton PD, Cooke TG. Sentinel node localization in patients with breast cancer. Br J Surg 1998; 85: 991–3.Google Scholar
  8. 8.
    Veneti S, Ioannidou-Mouzaka L, Toufexi H, Xenitides J, Anastasiadis P. Imprint cytology: a rapid, reliable method of diagnosing breast malignancy. Acta Cytol 1996; 40: 649–52.Google Scholar
  9. 9.
    Klimberg SV, Westbrook KC, Korkourian S. Use of touch preps for diagnosis and evaluation of surgical margins in breast cancer. Ann Surg Oncol 1998; 5: 220–6.Google Scholar
  10. 10.
    Cox CE, KuNN, Reintgen DS, Greenberg HM, Nicosia SV, Wangensteen S. Touch preparation cytology of breast lumpectomy margins with histologic correlation. Arch Surg 1991; 126: 490–3.Google Scholar
  11. 11.
    Robinson DS, Senofsky GM, Ketcham AS. Role and extent of lymphadenectomy for early breast cancer. Semin Surg Oncol 1992; 8: 78–82.Google Scholar
  12. 12.
    Kissin MW, Querci della Rovere G, Easton D, Westbury G. Risk of lymphoedema following the treatment of breast cancer. Br J Surg 1986; 73: 580–4.PubMedGoogle Scholar
  13. 13.
    Ivens D, Hoe AL, Podd TJ, Hamilton CR, Taylor I, Royle GT. Assessment of morbidity from complete axillary dissection. Br J Cancer 1992; 66: 136–8.Google Scholar
  14. 14.
    Steele RJ, Forrest AP, Gibson T, Stewart HJ, Chetty U. The efficacy of lower axillary sampling in obtaining lymph node status in breast cancer: a controlled randomized trial. Br J Surg 1985; 72: 368–9.PubMedGoogle Scholar
  15. 15.
    Rose CM, Botnick LE, Weinstein M, et al. Axillary sampling in the definitive treatment of breast cancer by radiation therapy and lumpectomy. Int J Radiat Oncol Biol Phys 1983; 9: 339–44.Google Scholar
  16. 16.
    Mathiesen O, Carl J, Bonderup O, Panduro J. Axillary sampling and the risk of erroneous staging of breast cancer: an analysis of 960 consecutive patients. Acta Oncol 1990; 29: 721–5.Google Scholar
  17. 17.
    Miltenburg DM, Miller C, Karamlou TB, Brunicardi FC. Meta-analysis of sentinel lymph node biopsy in breast cancer. J Surg Res 1999; 84: 138–42.Google Scholar
  18. 18.
    Giuliano AE. Mapping a pathway for axillary staging. Arch Surg 1999; 134: 195–9.PubMedGoogle Scholar
  19. 19.
    Pendas S, Dauway E, Cox CE, et al. Sentinel node biopsy and cytokeratin staining for the accurate staging of 478 breast cancer patients. Am Surg 1999; 65: 500–6.Google Scholar
  20. 20.
    Schreiber RH, Pendas S, KuNN, et al. Microstaging of breast cancer patients using cytokeratin staining of the sentinel lymph node. Ann Surg Oncol 1999; 6: 95–101.Google Scholar
  21. 21.
    Turner RR, Ollila DW, Krasne DL, Giuliano AE. Histopathologic validation of the sentinel lymph node hypothesis for breast carcinoma. Ann Surg 1997; 226: 271–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Czerniecki BJ, Scheff AM, Callans LS, et al. Immunohistochemistry with pancytokeratins improves the sensitivity of sentinel lymph node biopsy in patients with breast carcinoma. Cancer 1999; 85: 1098–103.Google Scholar
  23. 23.
    Viale G, Bosari S, Mazzarol G, et al. Intraoperative examination of axillary sentinel lymph nodes in breast carcinoma patients. Cancer 1999; 85: 2433–8.Google Scholar
  24. 24.
    Rimsten A, Johansson H, Stenkvist B. Perioperative diagnosis of axillary lymph nodes in cancer of the breast. Surg Gynecol Obstet 1974; 139: 551–4.Google Scholar
  25. 25.
    Quill DS, Leahy AL, Lawler RG, Finney RD. Lymph node imprint cytology for the rapid assessment of axillary node metastases in breast cancer. Br J Surg 1984; 71: 454–5.Google Scholar
  26. 26.
    Hadjiminas DJ, Burke M. Intraoperative assessment of nodal status in the selection of patients with breast cancer for axillary clearance. Br J Surg 1994; 81: 1615–6.Google Scholar
  27. 27.
    Rubio IT, Korkourian S, Cowan C, Krag DN, Colvert M, Klimberg VS. Use of touch preps for intraoperative diagnosis of sentinel lymph node metastases in breast cancer. Ann Surg Oncol 1998; 5: 689–94.Google Scholar
  28. 28.
    Ratanawichitrasin A, Biscotti CV, Levy L, Crowe JP. Touch imprint cytological analysis of sentinel lymph nodes for detecting axillary metastases in patients with breast cancer. Br J Surg 1999; 86: 1346–8.Google Scholar
  29. 29.
    Turner RT, Hansen NM, Stern SL, Giuliano AE. Intraoperative examination of the sentinel lymph node for breast carcinoma staging. Am J Clin Pathol 1999; 112: 627–634.Google Scholar
  30. 30.
    Dauway EL, Giuliano R, Haddad F, et al. Lymphatic mapping in breast cancer. Hematol/Oncol Clin North Am 1999; 13: 349–71.Google Scholar
  31. 31.
    KuNN. Pathologic examination of sentinel lymph nodes in breast cancer. Surg Oncol Clin North Am 1999; 8: 468–79.Google Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2001

Authors and Affiliations

  • John M. KaneIII
    • 1
  • Stephen B. Edge
    • 1
  • Janet S. Winston
    • 2
  • Nancy Watroba
    • 1
  • Thelma C. Hurd
    • 1
    • 3
  1. 1.Division of Surgical Oncology (JMK, SBE, NW, TCH)Roswell Park Cancer InstituteBuffalo
  2. 2.Division of Pathology (JSW)Roswell Park Cancer InstituteBuffalo
  3. 3.Surgical OncologyRoswell Park Cancer InstituteBuffalo

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