Is routine intraoperative frozen-section examination of sentinel lymph nodes in breast cancer worthwhile? Journal Article

Authors: Weiser, M. R.; Montgomery, L. L.; Susnik, B.; Tan, L. K.; Borgen, P. I.; Cody, H. S. 3rd
Article Title: Is routine intraoperative frozen-section examination of sentinel lymph nodes in breast cancer worthwhile?
Abstract: Background: Routine intraoperative frozen section (FS) of sentinel lymph nodes (SLN) can detect metastatic disease, allowing immediate axillary dissection and avoiding the need for reoperation. Routine FS is also costly, increases operative time, and is subject to false-negative results. We examined the benefit of routine intraoperative FS among the first 1000 patients at Memorial Sloan Kettering Cancer Center who had SLN biopsy for breast cancer. Methods: We performed SLN biopsy with intraoperative FS in 890 consecutive breast cancer patients, none of whom had a back-up axillary dissection planned in advance. Serial sections and immunohistochemical staining for cytokeratins were performed on all SLN that proved negative on FS. The sensitivity of FS was determined as a function of (1) tumor size and (2) volume of metastatic disease in the SLN, and the benefit of FS was defined as the avoidance of a reoperative axillary dissection. Results: The sensitivity of FS ranged from 40% for patients with T1a to 76% for patients with T2 cancers. The volume of SLN metastasis was highly correlated with tumor size, and FS was far more effective in detecting macrometastatic disease (sensitivity 92%) than micrometastases (sensitivity 17%). The benefit of FS in avoiding reoperative axillary dissection ranged from 4% for T1a (6 of 143) to 38% for T2 (45 of 119) cancers. Conclusions: In breast cancer patients having SLN biopsy, the failure of routine intraoperative FS is largely the failure to detect micrometastatic disease. The benefit of routine intraoperative FS increases with tumor size. Routine FS may not be indicated in patients with the smallest invasive cancers.
Keywords: immunohistochemistry; adult; human tissue; aged; aged, 80 and over; major clinical study; lymph node metastasis; lymphatic metastasis; diagnostic accuracy; sensitivity and specificity; sentinel lymph node biopsy; metastasis; breast cancer; breast neoplasms; axillary lymph node; intraoperative period; predictive value of tests; frozen section; frozen sections; lymph node biopsy; micrometastases; middle age; sentinel lymph nodes; macrometastases; human; female; article
Journal Title: Annals of Surgical Oncology
Volume: 7
Issue: 9
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2000-10-01
Start Page: 651
End Page: 655
Language: English
PUBMED: 11034241
PROVIDER: scopus
DOI: 10.1007/s10434-000-0651-3
Notes: Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, 2000 March 16–19, New Orleans, LA -- Export Date: 18 November 2015 -- Source: Scopus
Citation Impact
MSK Authors
  1. Lee K Tan
    144 Tan
  2. Hiram S Cody III
    232 Cody
  3. Barbara Susnik
    8 Susnik
  4. Patrick I Borgen
    253 Borgen
  5. Martin R Weiser
    421 Weiser