Abstract
Sentinel lymph node biopsy is an established practice to avoid axillary clearance, in clinically negative axilla, in breast cancer patients. Sentinel nodes harvested by dual technique, if found negative on intraoperative frozen section, can prevent breast cancer patient from a potentially debilitating complete axillary clearance. Hence, analyzing the institutional accuracy of this technique and comparing it with international standards, becomes important in providing optimal treatment to these patients. A retrospective analysis of all patients who had undergone sentinel lymph node biopsy at our institute from December 2014 to December 2018 was carried out. At our institute, sentinel lymph nodes are identified using dual technique of methylene blue and radiocolloid dye. Intraoperative frozen section of these hot or blue or any enlarged nodes is performed. Patients with positive frozen section undergo complete axillary clearance. All frozen and unfrozen biopsy material is subjected to further paraffin sectioning and immunohistochemistry. False negative rate and factors associated with were analyzed. A total number of 424 patients had undergone intraoperative frozen section for the sentinel node in breast cancer at our institute during the study period. Among these, 307 patients had negative sentinel nodes and 117 had positive sentinel nodes of frozen section. Seventeen patients out of 307 had lymph node metastases in final paraffin report (false negative rate = 12.6%). Two of these were found to have macrometastasis, 13 had micrometastasis and 2 had isolated tumor cells on final immunohistochemistry report. Size of metastases to sentinel lymph node was found to be a statistically significant contributor to higher false negative rate. Sentinel lymph node biopsy using intraoperative frozen section, is a sensitive and specific technique of staging axilla in breast cancer patients. Detection of micrometastasis and isolated tumor cells present a technical challenge and are associated with higher false negative rates.
Similar content being viewed by others
Data Availability
NA
Code Availability
None
References
Mansel RE, Fallowfield L, Kissin M et al (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial. J Natl Cancer Inst 98(9):599–609. https://doi.org/10.1093/jnci/djj158
Veronesi U, Viale G, Paganelli G et al (2010) Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study. Ann Surg 251(4):595–600. https://doi.org/10.1097/SLA.0b013e3181c0e92a
Wong J, Yong WS, Thike AA et al (2015) False negative rate for intraoperative sentinel lymph node frozen section in patients with breast cancer: a retrospective analysis of patients in a single Asian institution. J Clin Pathol 68(7):536–540. https://doi.org/10.1136/jclinpath-2014-202799
Chao C, Wong SL, Ackermann D et al (2001) Utility of intraoperative frozen section analysis of sentinel lymph nodes in breast cancer. Am J Surg 182(6):609–615. https://doi.org/10.1016/s0002-9610(01)00794-2
Turner RR, Hansen NM, Stern SL, Guiliano AE (1999) Intraoperative examination of the sentinel lymph node for breast carcinoma staging. Am J Clin Pathol 112:627–634
Weiser MR, Montgomery LL, Susnik B et al (2000) Is routine intraoperative examination of sentinel lymph nodes in breast cancer worthwhile? Ann Surg Oncol 7:651–655
Lu Q, Tan EY, Ho B, Teo C, Seah MDW, Chen JJC, Chan PMY (2013) Achieving breast cancer surgery in a single setting with intraoperative frozen section analysis of the sentinel lymph node. Clin Breast Cancer 13(2):140–145. https://doi.org/10.1016/j.clbc.2012.11.005
Kataria K, Srivastava A, Qaiser D (2016) What is a false negative sentinel node biopsy: definition, reasons and ways to minimize it? Indian J Surg 78(5):396–401. https://doi.org/10.1007/s12262-016-1531-9
Giuliano AE, Hunt KK, Ballman KV et al (2011) Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis. JAMA 305:569–575
Galimberti V, Cole BF, Zurrida S et al (2013) Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23–01): a phase 3 randomised controlled trial. Lancet Oncol 14:297–305
Gentilini O, Veronesi U (2012) Abandoning sentinel lymph node biopsy in early breast cancer? A new trial in progress at the European Institute of Oncology of Milan (SOUND: sentinel node vs observation after axillary UltraSouND). Breast 21:678–681
Author information
Authors and Affiliations
Contributions
All authors contributed in drafting, editing, revising and literature search.
Corresponding author
Ethics declarations
Ethics Approval and Consent to Participate
Waiver taken in view of a retrospective study. Patients gave written and informed consent for participation.
Consent for Publication
The patients gave written and informed consent for publication.
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Gupta, S., Kadayaprath, G., Ambastha, R. et al. False Negative Rate of Sentinel Lymph Node Biopsy on Intraoperative Frozen Section in Early Breast Cancer Patients: An Institutional Experience. Indian J Surg Oncol 13, 312–315 (2022). https://doi.org/10.1007/s13193-021-01458-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13193-021-01458-7