Intraoperative assessment via imprint cytology and frozen section or postoperative assessment of the sentinel lymph node
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Intraoperative Assessment Via Imprint Cytology and Frozen Section or Postoperative Assessment of the Sentinel Lymph Node in Breast Cancer? Original Article S. Lanitis, C. Poulou, V. Armoutidis, V. Samaras, G. Sgourakis, Ch. Karaliotas M. Korontzi, C. Tsikos, K. Barbatis, C. Karaliotas Received 18/03/2012 Accepted 23/05/2012
Abstract Aim-Background: Sentinel lymph node biopsy (SLNB) is considered the preferred method for the assessment of the axilla of a clinically node-negative breast cancer patient. Our aim was to assess the use of imprint cytology (IC) and frozen section (FS) on sentinel nodes. Patients-Methods: We prospectively studied 50 consecutive cases that underwent sentinel node biopsy (SLNB) along with surgical removal of the primary tumour. Results: The mean age of the patients was 56.36 years (32-81). The mean size of the invasive tumour was 23.74mm (0-80). Most tumours were grade 2 (50%), followed by grade 1(30%) and grade 3 (20%). A mean number of 1.82 (1-5) SLN were identified and removed. Overall, 36% of patients had positive nodes. In two cases, IC and FS missed the cancer cells; hence, the false negative rate when compared to the paraffin section was 11.1%. The sensitivity was 88.9% and the specificity 100% for both the IC and the FS. Conclusion: Taking in to account the current guidelines and recommendations for the SLN, we believe that an intraoperative assessment using FS is an accurate and reliable approach, sparing almost 90% of the SLN-positive patients from a second operation.
Key words:
Sentinel node biopsy, Frozen section, Imprint cytology, Intraoperative assessment, Breast cancer
Introduction The last 50 years have seen significant changes in S. Lanitis (Corresponding author), V. Armoutidis, G. Sgourakis, M. Korontzi, C. Tsikos - 2nd surgical Department and unit of Surgical Oncology “Korgialenio - Benakio”, Red Cross Athens General Hospital, Greece C. Poulou, V. Samaras, K. Barbatis - Pathology department “Korgialenio – Benakio”, Red Cross Athens General Hospital, Greece Ch. Karaliotas - Rheumatology and Rehabilitation department, VFN University Hospital, Prague, Czech Republic e-mail: [email protected]
the approach to both diagnosis and management of breast cancer. The method and role of surgery have changed and adjuvant treatment has evolved, improving the prognosis and prolonging survival. Nevertheless, despite the new development and knowledge of molecular medicine, axillary node status remains the most potent prognostic determinant in patients with early breast cancer [1]. Sentinel node biopsy (SLNB) was introduced less than 20 years ago as an alternative to Axillary lymph node dissection (ALND) for staging of the axilla [2,3]. Today, SLNB is considered a safe, accurate and sensitive, minimally invasive technique for staging the axilla of women with early breast cancer and clinically uninvolved axillary lymph nodes [4,5]. It is a targeted approach with low false negative rates, no obvious negative impact on locoregional control, and it is associated with significantly less mo
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