Intraoperative frozen section analysis of sentinel lymph nodes in breast cancer patients

A meta-analysis and single-institution experience

Authors

  • Liang-Chih Liu MD,

    1. Department of Surgery, Helen Diller and Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
    2. Department of Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China
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    • The first 2 authors contributed equally to this article.

  • Julie E. Lang MD,

    1. Department of Surgery, Helen Diller and Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
    2. Department of Surgery, University of Arizona, Tucson, Arizona
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    • The first 2 authors contributed equally to this article.

  • Ying Lu PhD,

    1. Department of Radiology, Helen Diller and Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
    2. Biostatistics Core, Helen Diller and Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
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  • Denise Roe DrPH,

    1. Department of Epidemiology and Biostatistics, School of Public Health, University of Arizona, Tucson, Arizona
    2. Section of Biometry, Arizona Cancer Center, University of Arizona, Tucson Arizona
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  • Shelley E. Hwang MD, MPH,

    1. Department of Surgery, Helen Diller and Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
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  • Cheryl A. Ewing MD,

    1. Department of Surgery, Helen Diller and Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
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  • Laura J. Esserman MD, MBA,

    1. Department of Surgery, Helen Diller and Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
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  • Eugene Morita MD,

    1. Department of Nuclear Medicine, University of California at San Francisco, San Francisco, California
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  • Patrick Treseler MD,

    1. Department of Pathology, University of California at San Francisco, San Francisco, California
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  • Stanley P. Leong MD

    Corresponding author
    1. Department of Surgery, Helen Diller and Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
    2. Department of Surgery, California Pacific Medical Center and Research Institute, San Francisco, California
    • Department of Surgery, California Pacific Medical Center, 2340 Clay Street, San Francisco, CA 94115
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    • Fax: (415) 600-3865


  • Presented in part at the 2009 Breast Cancer Symposium, American Society of Clinical Oncology; San Francisco, California; October 8-10, 2009.

Abstract

BACKGROUND:

Accurate intraoperative pathologic examination of sentinel lymph nodes (SLNs) has been an important tool that can reduce the need for reoperations in patients with SLN-positive breast cancer. The objective of the current study was to determine the accuracy of intraoperative frozen section (IFS) of SLNs during breast cancer surgery.

METHODS:

The authors retrospectively reviewed the records of 326 patients with breast cancer who underwent IF analysis of SLNs at a single institution. Then, they conducted a meta-analysis that included 47 published studies of IFS of SLNs in patients with breast cancer.

RESULTS:

Hematoxylin and eosin (H&E) staining revealed metastasis in SLNs in 99 patients (30.4%), including 61 patients with macrometastasis (MAM) (>2 mm) (the MAM group) and 38 patients with micrometastasis (Mi) or isolated tumor cell (ITC) deposits (the Mi/ITC group). The overall sensitivity of the institutional series was 60.6% (60 of 99 patients), and overall specificity was 100% (227 of 227 true negatives). The sensitivity of IFS was significantly lower in the Mi/ITC group (28.9%) than in the MAM group (80.3%; P < .0001). According to the meta-analysis of published studies and data from the author's institution (47 studies, for a total of 13,062 patients who underwent SLN dissection with IFS of SLNs), the mean sensitivity was 73%, and the mean specificity was 100%. The mean sensitivity was 94% for the MAM group and 40% for the Mi/ITC group.

CONCLUSIONS:

IFS of SLNs was more reliable for detecting MAM than for detecting Mi/ITC deposits. It lacked sufficient accuracy to rule out Mi/ITC deposits. Cancer 2011. © 2010 American Cancer Society.

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