Ann Surg Treat Res.  2022 May;102(5):241-247. 10.4174/astr.2022.102.5.241.

Avoiding unnecessary intraoperative sentinel lymph node frozen section biopsy of patients with early breast cancer

• Kang J
• Yoo TK
• Lee A
• Kang J
• Yoon CI
• Kang BJ
• Kim SH
• Park WC

• KMID: 2529498
• DOI: http://doi.org/10.4174/astr.2022.102.5.241

Abstract

Purpose
After the publication of the ACOSOG (American College of Surgeons Oncology Group) Z0011 trial, the rate of axillary lymph node dissection has reduced. Thus, the need for intraoperative frozen section biopsy of sentinel lymph nodes (SLNs) has become controversial. We identified patients for whom intraoperative SLN frozen section biopsy could be omitted and found that frozen section biopsy rate can be reduced.
Methods
We reviewed the records of patients with tumors ≤5 cm in diameter who underwent breast-conserving surgery between January 2013 and December 2019 at Seoul St. Mary’s Hospital. Clinicopathological and imaging characteristics were compared according to number of positive SLNs (0–2 SLNs positive vs. ≥3 SLNs positive).
Results
A total of 1,983 patients were included in this study. Thirty-two patients (1.6%) had at least 3 positive SLNs. Patients with ≥3 positive SLNs had significantly larger tumors and were more frequently high-grade tumors (P < 0.001 and P = 0.002, respectively). Identification of suspicious lymph nodes on imaging studies was also associated with the presence of ≥3 positive SLNs (hazard ratio, 11.54; 95% confidence interval, 4.42–30.10). All patients with none or only 1 suspicious lymph node on any imaging modality (n = 647, 32.6%) had 0–2 positive SLNs. Also, among patients with clinical T1-stage tumors and at least 2 suspicious lymph nodes on only 1 imaging modality (n = 514, 25.9%), only 2 cases had ≥3 positive SLNs.
Conclusion
We found that intraoperative SLN frozen biopsy could be omitted in patients using tumor size and axillary lymph node status on imaging modality.

Keyword

Breast neoplasms; Frozen sections biopsy; Magnetic resonance imaging; Sentinel lymph node

Figure

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  Fig. 1 Flowchart of the patients. ALND, axillary lymph node dissection; ALN, axillary lymph node; SLN, sentinel lymph node.

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  Fig. 2 Number of patients that can be considered of sentinel lymph node frozen section biopsy omission. Group 1, no or only 1 suspicious lymph node in all radiologic tests; group 2, clinical tumor size of ≤2 cm and 2 or more suspicious lymph nodes in only 1 radiologic test.

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