Is Routine Intraoperative Frozen Section Analysis of Sentinel Lymph Nodes Necessary in Every Early-Stage Breast Cancer?
ACOSOG Z0011
breast cancer
intraoperative frozen section analysis
sentinel lymph node biopsy
Journal
Breast cancer (Dove Medical Press)
ISSN: 1179-1314
Titre abrégé: Breast Cancer (Dove Med Press)
Pays: New Zealand
ID NLM: 101591856
Informations de publication
Date de publication:
2022
2022
Historique:
received:
30
06
2022
accepted:
08
09
2022
entrez:
26
9
2022
pubmed:
27
9
2022
medline:
27
9
2022
Statut:
epublish
Résumé
Clinical application of the ACOSOG Z0011 trial results allows clinically node-negative breast cancer patients who meet criteria to avoid axillary dissection even when 1-2 sentinel lymph nodes (SLNs) are positive for metastatic disease. Intraoperative frozen section (iFS) analyses of SLNs were thought to reduce re-operation rates despite variable reported sensitivity and possibility of a false negative result. This study evaluated the rate of re-operations prevented by SLN iFS in a tertiary care hospital in Bangkok, Thailand, over a 6-year time-frame. From April 2016 to April 2022, 1284 sentinel lymph node biopsy (SLNB) procedures were performed. Of these, 214 cases were breast-conserving surgery in accordance with the ACOSOG criteria with concomitant usage of iFS. Clinicopathological features of these cases were collected and analyzed. Re-operation rates prevented by the additional intervention were reported. Only five additional operations were prevented with the usage of 214 iFS. The discordance rate between frozen and permanent sections in terms of presence of metastatic disease and number of total lymph nodes was around 15%. Tumor staging, node staging, Nottingham histologic grading and lymphovascular invasion are significant predictors of SLN metastasis. iFS results in a very low prevention rate for follow-up ALND in patients with preoperative clinically negative axillary nodes and is associated with a non-negligible discordance rate with permanent sections. Our study suggests iFS may be avoided in most cases of early-stage clinically and radiographically node-negative breast cancer patients. Doing so may reduce surgical costs and total operative time without a significant impact on the overall quality of treatment and standard of care.
Identifiants
pubmed: 36158940
doi: 10.2147/BCTT.S380579
pii: 380579
pmc: PMC9507279
doi:
Types de publication
Journal Article
Langues
eng
Pagination
281-290Informations de copyright
© 2022 Lerttiendamrong et al.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest in this work.
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