Discordance of Intraoperative Frozen Section Analysis with Definitive Histology of Sentinel Lymph Nodes in Breast Cancer Surgery: Complementary Axillary Lymph Node Dissection is Irrelevant for Subsequent Systemic Therapy
| Autor: | J. van Gorp, Th. van Dalen, E. V. E. Madsen, P. de Hooge, Paul D. Gobardhan, D. Geertsema, M. Albregts |
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| Jazyk: | angličtina |
| Předmět: |
Adult
medicine.medical_specialty Breast surgery medicine.medical_treatment Breast Neoplasms Breast Oncology Intraoperative Period Breast cancer medicine Frozen Sections Humans Prospective Studies Lymph node Aged Neoplasm Staging Aged 80 and over Frozen section procedure business.industry Sentinel Lymph Node Biopsy Carcinoma Ductal Breast Axillary Lymph Node Dissection Middle Aged medicine.disease Prognosis Surgery Axilla Carcinoma Lobular medicine.anatomical_structure Oncology Lymphatic Metastasis Lymph Node Excision Female Lymph Lymph Nodes business Follow-Up Studies |
| Zdroj: | Annals of Surgical Oncology |
| ISSN: | 1068-9265 |
| DOI: | 10.1245/s10434-010-1052-x |
| Popis: | Background In breast cancer surgery, intraoperative frozen section (FS) analysis of sentinel lymph nodes (SLNs) enables axillary lymph node dissection (ALND) during the same operative procedure. In case of discordance between a “negative” FS analysis and definitive histology, an ALND as a second operation is advocated since additional lymph node metastases may be present. The clinical implications of the subsequent ALND in these patients were evaluated. Materials and Methods Between November 2000 and May 2008, 879 consecutive breast cancer patients underwent surgery including sentinel lymph node biopsy (SLNB) with intraoperative FS analysis of 2 central cuts from axillary SLNs. Following fixation and serial sectioning, SLNs were further examined postoperatively with hematoxylin and eosin (H&E) and immunohistochemical techniques. For patients with a discordant FS examination, the effect of the pathology findings of the subsequent ALND specimen on subsequent nonsurgical therapy were evaluated. Results FS analysis detected axillary metastases in the SLN(s) in 200 patients (23%), while the definitive pathology examination detected metastases in SLNs in another 151 patients (17%). A complementary ALND was performed in 108 of the 151 patients with discordant FS. Additional tumor positive axillary lymph nodes were found in 17 patients (16%), leading to “upstaging” in 7 (6%). Subsequent nonsurgical treatment was adjusted in 4 patients (4%): all 4 had more extensive locoregional radiotherapy; no patient received additional hormonal and/or chemotherapy. Conclusion Discordance between intraoperative FS analysis and definitive histology of SLNs is common. In this selection of patients, a substantial proportion had additional lymph node metastases, but postsurgical treatment was rarely adjusted based on the findings of the complementary ALND. |
| Databáze: | OpenAIRE |
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