Breast Cancer Research and Treatment

, Volume 113, Issue 1, pp 129–136

Accuracy of frozen section of sentinel lymph nodes: a prospective analysis of 659 breast cancer patients of the Swiss multicenter study

  • Igor Langer
  • Ulrich Guller
  • Gilles Berclaz
  • Ossi R. Koechli
  • Holger Moch
  • Gabriel Schaer
  • Mathias K. Fehr
  • Thomas Hess
  • Daniel Oertli
  • Lucio Bronz
  • Beate Schnarwyler
  • Edward Wight
  • Urs Uehlinger
  • Eduard Infanger
  • Daniel Burger
  • Markus Zuber
  • For the Swiss Multicenter Study Group Sentinel Lymph Node in Breast Cancer
Clinical Trial

Abstract

Objective To assess the accuracy of sentinel lymph node (SLN) frozen section in a prospective multicenter study of early-stage breast cancer patients. Summary background data The decision to perform an immediate completion axillary node dissection (ALND) is based on results of SLN frozen section. However, SLN frozen sections are not routinely performed in all centers. Moreover, the accuracy of SLN frozen section remains a matter of great debate. Methods Prospective multicenter trial analyzing 659 early stage breast cancer patients (pT1 and pT2 ≤ 3 cm, cN0) enrolled between January 2000 and December 2003. SLN were intraoperatively examined by frozen section. Final histopathology consisted in performing step sectioning as well as staining with H&E and immunohistochemistry. Results SLN were identified in 98.3% (648/659) of all patients. The accuracy of frozen section was 90.1% (584/648), the sensitivity for SLN macro-metastases 98% (142/145), and the specificity 100%. A total of 47 patients with SLN micro-metastases (n = 36) or isolated tumor cells (n = 11) underwent a delayed completion ALND. In 96% (45/47) of these patients the ALND specimens were free of macro-metastases. Conclusions SLN frozen section provides highly accurate information regarding identification of SLN macro-metastases, a delayed completion ALND can be avoided in 98% of these patients. More importantly, in the present investigation the vast majority (96%) of patients with SLN micro-metastases or isolated tumor cells undergoing delayed completion ALND did not benefit from the second operation as ALND specimens were free of macro-metastases. We strongly recommend the routine use of SLN frozen section in early stage breast cancer patients.

Keywords

Accuracy Frozen section Sentinel lymph node Breast cancer Micrometastases 

Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Igor Langer
    • 1
  • Ulrich Guller
    • 1
  • Gilles Berclaz
    • 2
  • Ossi R. Koechli
    • 3
  • Holger Moch
    • 4
  • Gabriel Schaer
    • 5
  • Mathias K. Fehr
    • 6
  • Thomas Hess
    • 7
  • Daniel Oertli
    • 1
  • Lucio Bronz
    • 8
  • Beate Schnarwyler
    • 9
  • Edward Wight
    • 10
  • Urs Uehlinger
    • 11
  • Eduard Infanger
    • 12
  • Daniel Burger
    • 12
  • Markus Zuber
    • 13
  • For the Swiss Multicenter Study Group Sentinel Lymph Node in Breast Cancer
    • 14
  1. 1.Divisions of General Surgery and Surgical ResearchUniversity Hospital BaselBaselSwitzerland
  2. 2.Division of GynecologyUniversity Hospital BerneBerneSwitzerland
  3. 3.Bethanien ClinicZurichSwitzerland
  4. 4.Institute of PathologyUniversity Hospital BaselBaselSwitzerland
  5. 5.Department of Obstetrics and GynecologyKantonsspital AarauAarauSwitzerland
  6. 6.Division of GynecologyUniversity Hospital ZurichZurichSwitzerland
  7. 7.Division of GynecologyKantonsspital WinterthurWinterthurSwitzerland
  8. 8.Department of Obstetrics and GynecologyOspedale San GiovanniBellinzonaSwitzerland
  9. 9.MaternitéStadtspital TriemliZurichSwitzerland
  10. 10.Division of GynecologyUniversity Hospital BaselBaselSwitzerland
  11. 11.Department of Obstetrics and GynecologyKantonsspital BruderholzBinningenSwitzerland
  12. 12.Department of Obstetrics and GynecologyKantonales Spital Sursee-WolhusenSurseeSwitzerland
  13. 13.Department of SurgeryKantonsspital OltenOltenSwitzerland
  14. 14.BaselSwitzerland

Personalised recommendations