Ann Surg Treat Res.  2019 Aug;97(2):49-57. 10.4174/astr.2019.97.2.49.

Is the frozen section examination for sentinel lymph node necessary in early breast cancer patients?

Affiliations
  • 1Department of Surgery, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea.
  • 2Division of Breast Surgery, Department of Surgery, Breast Cancer Center, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. youngup@yuhs.ac

Abstract

PURPOSE
Sentinel lymph node (SLN) biopsy (SLNB) is widely performed for axillary staging in patients with breast cancer. Based on the results of frozen section examination (FSE), surgeons can decide to continue further axillary dissections. This study aimed to verify the accuracy of FSE for SLNs.
METHODS
We reviewed the records of 4,219 patients who underwent SLNB for primary invasive breast cancer between 2007 and 2016 at the Severance Hospital. We evaluated factors associated with the false-negative results of FSE for SLNs using the Generalized Estimating Equations model.
RESULTS
A total of 1,397 SLNs from 908 patients were confirmed to be metastatic. Seventy-one patients (1.7%) had confirmed pathologic N2 or N3 stage. Among metastatic SLNs, micrometastasis was found in 234 (16.8%). The overall accuracy of SLNB was 98.5%. The sensitivity and false-negative rate of FSE were 86.4% and 13.6%, respectively. Several clinicopathological factors, including the size of SLN metastases, suspicious preoperative axillary lymph nodes, and luminal B subtype, were associated with a higher rate of false-negative results.
CONCLUSION
Most patients were not indicated for axillary lymph node dissection. Some patients may show transition in their permanent pathology due to the size of the metastatic node. However, the false-negative results of FSE for SLNs based on the size of the metastatic node did not change our practice. Therefore, intraoperative FSE for SLN should not be routinely performed for all breast cancer patients.

Keyword

Breast neoplasms; False negative reactions; Frozen sections; Sentinel lymph node biopsy

MeSH Terms

Biopsy
Breast Neoplasms*
Breast*
False Negative Reactions
Frozen Sections*
Humans
Lymph Node Excision
Lymph Nodes*
Neoplasm Metastasis
Neoplasm Micrometastasis
Pathology
Phenobarbital
Sentinel Lymph Node Biopsy
Surgeons
Phenobarbital
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