Omission of routine frozen section for clinically node-negative patients undergoing upfront mastectomy avoids unnecessary axillary treatment Journal Article
| Authors: | Sargent, R. E.; Barrio, A. V.; Sevilimedu, S. V.; Khan, A. J.; Morrow, M.; Mamtani, A. |
| Article Title: | Omission of routine frozen section for clinically node-negative patients undergoing upfront mastectomy avoids unnecessary axillary treatment |
| Abstract: | Background: Randomized trials established the safety of postmastectomy radiation/regional nodal irradiation (PMRT) as an alternative to axillary lymph node dissection (ALND) for cN0 patients undergoing upfront mastectomy with one or two positive sentinel lymph nodes (+SLNs). In January 2022, the authors adopted a policy omitting routine frozen section for cT1-3N0 patients undergoing upfront mastectomy, and this study sought to examine the impact of this policy on axillary treatment. Methods: Consecutive patients with cT1-3N0 breast cancer who underwent upfront mastectomy from January 2022 to July 2023 were identified. For patients with three or more +SLNs and those with one or two +SLNs not meeting institutional PMRT criteria, ALND was indicated. This study evaluated ALND/PMRT rates after adoption of this policy. Results: In this study, 623 patients with cT1-3N0 breast cancer had upfront mastectomy with sentinel lymph node biopsy. Overall, 4.7% (n = 29) of the patients had completion ALND (cALND). These patients had larger tumors, and more often had lobular histology and LVI. Of 98 patients with one or two +SLNs, 86 (88%) underwent PMRT and no further surgery, and 8 (8%) had ALND due to no initial PMRT indication, of whom 2 then met PMRT criteria based on additional positive nodes, and 4 had neither. Among those with three or more +SLNs (n = 29), 21 (72%) underwent both ALND and PMRT, and 8 (28%) had PMRT alone or neither treatment. Overall, return to the operating room for ALND was indicated for 39 (6.2%) of the 623 patients with three or more +SLNs and for those who had one or two +SLNs without PMRT indication. Conclusions: In this study, only 6% of the cN0 patients who had SLN frozen section omitted at upfront mastectomy exhibited an indication for cALND. Receipt of ALND+PMRT for the patients with involvement of one or two nodes was rare, occurring for just 2% of the patients. Axillary management was optimized by routine omission of frozen section for cT1-3N0 patients undergoing upfront mastectomy. © Society of Surgical Oncology 2025. |
| Keywords: | sentinel lymph node biopsy; breast cancer; mastectomy; alnd; axillary dissection; postmastectomy radiation therapy; pmrt |
| Journal Title: | Annals of Surgical Oncology |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Publication status: | Online ahead of print |
| Date Published: | 2025-07-16 |
| Online Publication Date: | 2025-07-16 |
| Language: | English |
| DOI: | 10.1245/s10434-025-17784-x |
| PROVIDER: | scopus |
| PUBMED: | 40670840 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Anita Mamtani -- Source: Scopus |
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