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

Liang Chih Liu, Julie E. Lang, Ying Lu, Denise Roe, Shelley E. Hwang, Cheryl A. Ewing, Laura J. Esserman, Eugene Morita, Patrick Treseler, Stanley P. Leong

Research output: Contribution to journalArticle

58 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)250-258
Number of pages9
JournalCancer
Volume117
Issue number2
DOIs
StatePublished - Jan 15 2011

Fingerprint

Frozen Sections
Neoplasm Micrometastasis
Breast Neoplasms
Neoplasms
Meta-Analysis
Sentinel Lymph Node
Hematoxylin
Eosine Yellowish-(YS)
Lymph Node Excision
Reoperation
Staining and Labeling
Neoplasm Metastasis

Keywords

  • breast cancer
  • frozen section
  • intraoperative evaluation
  • meta-analysis
  • sentinel lymph node

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Liu, L. C., Lang, J. E., Lu, Y., Roe, D., Hwang, S. E., Ewing, C. A., ... Leong, S. P. (2011). Intraoperative frozen section analysis of sentinel lymph nodes in breast cancer patients. Cancer, 117(2), 250-258. https://doi.org/10.1002/cncr.25606

Intraoperative frozen section analysis of sentinel lymph nodes in breast cancer patients. / Liu, Liang Chih; Lang, Julie E.; Lu, Ying; Roe, Denise; Hwang, Shelley E.; Ewing, Cheryl A.; Esserman, Laura J.; Morita, Eugene; Treseler, Patrick; Leong, Stanley P.

In: Cancer, Vol. 117, No. 2, 15.01.2011, p. 250-258.

Research output: Contribution to journalArticle

Liu, LC, Lang, JE, Lu, Y, Roe, D, Hwang, SE, Ewing, CA, Esserman, LJ, Morita, E, Treseler, P & Leong, SP 2011, 'Intraoperative frozen section analysis of sentinel lymph nodes in breast cancer patients', Cancer, vol. 117, no. 2, pp. 250-258. https://doi.org/10.1002/cncr.25606
Liu, Liang Chih ; Lang, Julie E. ; Lu, Ying ; Roe, Denise ; Hwang, Shelley E. ; Ewing, Cheryl A. ; Esserman, Laura J. ; Morita, Eugene ; Treseler, Patrick ; Leong, Stanley P. / Intraoperative frozen section analysis of sentinel lymph nodes in breast cancer patients. In: Cancer. 2011 ; Vol. 117, No. 2. pp. 250-258.
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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.",
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AU - Liu, Liang Chih

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AU - Roe, Denise

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AU - Ewing, Cheryl A.

AU - Esserman, Laura J.

AU - Morita, Eugene

AU - Treseler, Patrick

AU - Leong, Stanley P.

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N2 - 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.

AB - 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.

KW - breast cancer

KW - frozen section

KW - intraoperative evaluation

KW - meta-analysis

KW - sentinel lymph node

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