Breast cancer patients with pN0(i+) and pN1(mi) sentinel nodes have high rate of nonsentinel node metastases.
Journal - Journal of the American College of Surgeons (United States )
BACKGROUND: The recent American Joint Committee on Cancer revision of the staging system for breast cancer classifies sentinel node metastases < 0.2 mm (pN0[i+]) as node negative and those > 0.2 mm but < 2 mm are designated pN1(mi). We examined the association between size of sentinel node metastases and rate of nonsentinel node metastases, specifically in the subgroup of patients with micrometastases. STUDY DESIGN: We examined the nonsentinel nodes of 124 patients with positive sentinel nodes and correlated the likelihood of nonsentinel node involvement with the size of the metastasis in the sentinel node and primary tumor characteristics. RESULTS: Nonsentinel node metastases were found in 19% (6 of 31) of patients with sentinel node metastases 2 mm. Multivariate analysis found that involvement of the majority of sentinel nodes (p = 0.01) and sentinel metastases > 2 mm (p = 0.001) were significantly related to presence of metastases in nonsentinel nodes. Age, tumor size, pathology, multifocality, satellites, and lymphovascular invasion were not significantly related to nonsentinel node metastases in multivariate analysis. CONCLUSIONS: These findings indicate that frequency of nonsentinel node metastases with sentinel node metastases 0.2 to 2 mm. Omitting complete axillary dissection in pN1(mi) and pN0(i+) patients may leave residual disease in up to 20% of these patients.
|ISSN : ||1072-7515|
|Mesh Heading : ||Adult Aged Axilla Breast Neoplasms Carcinoma in Situ Carcinoma, Ductal, Breast Carcinoma, Lobular Female Humans Lymph Nodes Lymphatic Metastasis Middle Aged Multivariate Analysis Neoplasm Invasiveness Radiopharmaceuticals Retrospective Studies Sentinel Lymph Node Biopsy Technetium Tc 99m Sulfur Colloid epidemiology radionuclide imaging epidemiology pathology radionuclide imaging diagnosis epidemiology diagnosis epidemiology radionuclide imaging diagnostic use diagnostic use|
|Mesh Heading Relevant : ||pathology secondary secondary pathology|
Touch preparation or frozen section for intraoperative detection of sentinel lymph node metastases from breast cancer.
Journal - Annals of surgical oncology (United States )
BACKGROUND: The preferred technique for intraoperative evaluation of the sentinel lymph node has not been determined. The purpose of this study was to compare the sensitivity and accuracy of intraoperative evaluation of the sentinel lymph node by touch preparation cytology and frozen section. METHODS: A total of 117 patients with clinically node-negative breast cancer or ductal carcinoma-in-situ undergoing sentinel lymph node biopsy had intraoperative evaluation of the sentinel node by touch preparation, frozen section, or both. The results of the intraoperative evaluation were compared with the final histological results of hematoxylin and eosin (H&E) paraffin section and immunohistochemistry (IHC). RESULTS: Twenty-six (57%) of the 46 patients with nodal involvement had metastases detected during surgery. The sensitivity of touch preparation for detecting macrometastases was 78%; for detecting all H&E metastases, including micrometastases, was 57%; and for detecting all metastases, including those seen on IHC, was 40%. The sensitivity of frozen section for detecting macrometastases was 83%; for detecting all H&E metastases, including micrometastases, was 78%; and for detecting all metastases, including those seen on IHC, was 64%. Both have a low sensitivity for micrometastases seen by H&E paraffin section: 57% and 78%, respectively. Neither detected micrometastases diagnosed by IHC only. CONCLUSIONS: Both touch preparation and frozen section seem to be accurate in detecting macrometastases, but not micrometastases. Intraoperative evaluation of the sentinel lymph node by touch preparation allows for a quick evaluation of the node without wasting significant tissue and without detecting occult microscopic metastases, which may be beneficial because the clinical importance of these has yet to be elucidated.
|ISSN : ||1068-9265|
|Mesh Heading : ||Adult Aged Aged, 80 and over Breast Neoplasms Carcinoma in Situ Carcinoma, Intraductal, Noninfiltrating Cytodiagnosis Female Humans Intraoperative Period Lymph Node Excision Lymph Nodes Lymphatic Metastasis Middle Aged Predictive Value of Tests Retrospective Studies Sensitivity and Specificity surgery surgery surgery pathology|
|Mesh Heading Relevant : ||Axilla Frozen Sections Sentinel Lymph Node Biopsy pathology pathology pathology methods pathology|