Annals of Surgical Oncology

, Volume 8, Issue 10, pp 817–820 | Cite as

The Problem of the Accuracy of Intraoperative Examination of Axillary Sentinel Nodes in Breast Cancer

  • Stefano Zurrida
  • Giovanni Mazzarol
  • Viviana Galimberti
  • Giuseppe Renne
  • Fabio Bassi
  • Franco Iafrate
  • Giuseppe Viale
Article

Abstract

Background: Sentinel node SN biopsy has become accepted as a reliable method of predicting the state of the axilla in breast cancer. The key issue, however, is the accuracy of the pathological evaluation of the biopsied node, which should be done intraoperatively whenever possible.

Methods: In our initial experience on 192 patients using a conventional intraoperative frozen section method, the false-negative rate was 6.3%, and the negative predictive value was 93.7%. We devised a new and exhaustive intraoperative method, requiring about 40 minutes, in which pairs of sections are taken every 50 μ for the first 15 sections and every 100 μ thereafter, sampling the entire node. Sentinel node metastases were found in 143 of the 376 T1N0 cases examined 38%.

Results: Metastases were always identified on hematoxylin and eosin sections, although in 4% of cases, cytokeratin immunostaining on adjacent sections was useful for confirming malignancy. In 233 patients the SNs were disease-free; of these patients, 222 had metastasis-free axillary nodes, and 11 4.7% had another metastatic node.

Conclusion: Extensive intraoperative examination of frozen sentinel nodes correctly predicts an uninvolved axilla in 95.3% of cases negative predictive value. This method is, therefore, suitable for identifying patients in whom axillary dissection can be avoided.

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References

  1. 1.
    Viale G, Bosari S, Mazzarol G, et al. Intraoperative examination of axillary sentinel nodes in breast cancer patients. Cancer 1999; 85: 1433–8.Google Scholar
  2. 2.
    Motomura K, Inaji H, Komoike Y, Kasugai T, Noguchi S, Koyama H. Sentinel node biopsy guided by indocyanine green dye in breast cancer patients. Jpn J Clin Oncol 1999; 29: 604–7.Google Scholar
  3. 3.
    Nos C, Bourgeois D, Freneaux P, Zafrani B, Salmon RJ, Clough KB. Identification of sentinel lymph node in breast cancer: experience from the Institut Curie. Bull Cancer 1999; 86: 580–4.Google Scholar
  4. 4.
    Winchester DJ, Sener SF, Winchester DP, et al. Sentinel lymphadenectomy for breast cancer: experience with 180 consecutive patients: efficacy of filtered technetium-99m sulphur colloid with overnight migration time. J Am Coll Surg 1999; 188: 597–603.Google Scholar
  5. 5.
    Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer—a multicenter validation study. N Engl J Med 1998; 339: 941–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Rodier JF, Routiot T, Mignotte H, et al. Identification of axillary sentinel node by lymphotropic dye in breast cancer. Feasibility study apropos of 128 cases. Chirurgie 1998; 123: 239–46.Google Scholar
  7. 7.
    Guenther JM, Krishnamoorthy M, Tan LR. Sentinel lymphadenectomy for breast cancer in a community managed care setting. Cancer J Sci Am 1997; 3: 336–40.PubMedGoogle Scholar
  8. 8.
    Kollias J, Gill PG, Chatterton BE, Hall VE, Bochner MA, Coventry BJ, Farshid G. Reliability of sentinel node status in predicting axillary lymph node involvement in breast cancer. Med J Aust 1999; 171: 461–5.Google Scholar
  9. 9.
    Morrow M, Rademaker AW, Bethke KP, Talamonti MS, Dawes LG, Clauson J, Hansen N. Learning sentinel node biopsy: results of a prospective randomized trial of two techniques. Surgery 1999; 126: 714–22.Google Scholar
  10. 10.
    Pendas S, Dauway E, Cox CE, Giuliano R, KuNN, Schreiber RH, Reintgen DS. Sentinel node biopsy and cytokeratin staining for the accurate staging of 478 breast cancer patients. Am Surg 1999; 65: 500–6.Google Scholar
  11. 11.
    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
  12. 12.
    Borgstein PJ, Pijpers R, Comans EF, van Diest PJ, Boom RP, Meijer S. Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg 1998; 186: 275–83.CrossRefPubMedGoogle Scholar
  13. 13.
    Cox CE, Pendas S, Cox JM, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg 1998; 227: 645–53.CrossRefPubMedGoogle Scholar
  14. 14.
    Veronesi U, Paganelli G, Viale G, et al. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 1999; 91: 368–73.CrossRefPubMedGoogle Scholar
  15. 15.
    Gershenwald JE, Thompson W, Mansfield PF, et al. Multi institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol 1999; 17: 976–83.PubMedGoogle Scholar
  16. 16.
    Zurrida S, Galimberti V, Orvieto E, et al. Radioguided sentinel node biopsy to avoid axillary dissection in breast cancer. Ann Surg Oncol 2000; 7: 28–31.Google Scholar
  17. 17.
    Veronesi U, Paganelli G, Galimberti V, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph nodes. The Lancet 1997; 349: 1864–7.Google Scholar
  18. 18.
    Chilosi M, Lestani M, Pedron S, et al. A rapid immunostaining method for frozen sections. Biotech Histochem 1994; 69: 235–9.Google Scholar
  19. 19.
    Albertini JJ, Lyman GH, Cox C, Yeatman T, Balducci L, KuN. Lymphatic mapping and entinel node biopsy in the patient with breast cancer. JAMA 1996; 276: 1818–22.CrossRefPubMedGoogle Scholar
  20. 20.
    Krag DN, Ashikaga T, Harlow SP, Weaver DL. Development of sentinel node targeting technique in breast cancer patients. Breast J 1998; 4(2): 67–74.Google Scholar
  21. 21.
    Giuliano AE. Sentinel lymphadenectomy in primary breast carcinoma: an alternative to routine axillary dissection. J Surg Oncol 1996; 62: 75–7.Google Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2001

Authors and Affiliations

  • Stefano Zurrida
    • 1
    • 3
  • Giovanni Mazzarol
    • 2
  • Viviana Galimberti
    • 1
  • Giuseppe Renne
    • 2
  • Fabio Bassi
    • 1
  • Franco Iafrate
    • 1
  • Giuseppe Viale
    • 2
  1. 1.Department of SenologyUniversity of Milan School of Medicine, European Institute of OncologyMilanItaly
  2. 2.Department of Pathology and Laboratory MedicineUniversity of Milan School of Medicine, European Institute of OncologyMilanItaly
  3. 3.Scientific Director’s OfficeEuropean Institute of OncologyMilanoItaly

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