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

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Abstract

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.

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Authors and Affiliations

  1. Division of Surgical Oncology (JMK, SBE, NW, TCH), Roswell Park Cancer Institute, Buffalo, New York

    John M. Kane III MD, Stephen B. Edge MD, Nancy Watroba MPA & Thelma C. Hurd MD

  2. Division of Pathology (JSW), Roswell Park Cancer Institute, Buffalo, New York

    Janet S. Winston MD

  3. Surgical Oncology, Roswell Park Cancer Institute, Elm & Carlton Street, Buffalo, NY, 14263

    Thelma C. Hurd MD

Authors
  1. John M. Kane III MD
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  2. Stephen B. Edge MD
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  3. Janet S. Winston MD
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  4. Nancy Watroba MPA
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  5. Thelma C. Hurd MD
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Corresponding author

Correspondence to Thelma C. Hurd MD.

Additional information

Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, New Orleans, Louisiana, March 16-19, 2000.

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Kane, J.M., Edge, S.B., Winston, J.S. et al. Intraoperative Pathologic Evaluation of a Breast Cancer Sentinel Lymph Node Biopsy as a Determinant for Synchronous Axillary Lymph Node Dissection. Ann Surg Oncol 8, 361–367 (2001). https://doi.org/10.1007/s10434-001-0361-5

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  • DOI: https://doi.org/10.1007/s10434-001-0361-5

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