Absence of ectopic epithelial inclusions in 3,904 axillary lymph nodes examined in sentinel technique
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Intraoperative examination of sentinel axillary lymph nodes can be done by imprint cytology, frozen section, or, most recently, by PCR-based amplification of a cytokeratin signal. Using this technique, benign epithelial inclusions, representing mammary tissue displaced along the milk line, will likely generate a positive PCR signal and lead to a false-positive diagnosis of metastatic disease. To better appreciate the incidence of ectopic epithelial inclusions in axillary lymph nodes, we have performed an autopsy study, examining on 100 μm step sections 3,904 lymph nodes obtained from 160 axillary dissections in 80 patients. The median number of lymph nodes per axilla was 23 (15, 6, and 1 in levels 1, 2, and 3, respectively). A total of 30,450 hematoxylin-eosin stained slides were examined, as well as 8,825 slides immunostained with pan-cytokeratin antibodies. Despite this meticulous work-up, not a single epithelial inclusion was found in this study, suggesting that the incidence of such inclusions is much lower than the assumed 5% reported in the literature.
KeywordsBenign epithelial inclusions Sentinel lymph node Polymerase chain reaction Autopsy Axillary lymph nodes
We are grateful to Aziz Chaouch (University Institute of Social and Preventive Medicine, Lausanne) for helping with the statistical data analysis. This study is part of the doctoral dissertation of Sonja Iken (University of Mainz, Mainz, Germany). Sonja Iken has performed the axillary dissections in the autopsy suite under guidance and close supervision of Marcus Schmidt and analyzed all the histological and immunohistochemical slides. Claudia Braun and Antonietta Valentino have provided the technical platform for the histological work-up and the immunohistochemical analyses. Hans-Anton Lehr and Stephan Schaefer have planned the study, advised Sonja Iken during her doctoral dissertation, verified the histological and immunohistochemical analyses, and written the article. All authors have read and approved the final manuscript. The authors wish to express their deep gratitude to Prof. C. James Kirkpatrick, chairman of the department of pathology, for providing an atmosphere of scientific curiosity and immense freedom, in which this and many other studies could flourish.
Conflict of interest
The authors declare that they have no competing interests.
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