Improved detection of sentinel lymph node metastases allows reliable intraoperative identification of patients with extended axillary lymph node involvement in early breast cancer

URN to cite this document:

urn:nbn:de:bvb:355-epub-506079 Copy

DOI to cite this document:

10.5283/epub.50607 Copy

Cotarelo, Cristina L. ; Zschöck-Manus, Annemarie ; Schmidt, Marcus ; Schad, Arno ; Brochhausen, Christoph ; Kirkpatrick, Charles James ; Thaler, Sonja

License: Creative Commons Attribution 4.0 PDF - Published Version (1MB)

Date of publication of this fulltext: 11 Oct 2021 13:10

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Details

Item type:	Article
Open Access Type:	DEAL (Springer) - Non UR
Journal or Publication Title:	Clinical & Experimental Metastasis
Publisher:	Springer
Place of Publication:	DORDRECHT
Volume:	38
Number of Issue or Book Chapter:	1
Page Range:	pp. 61-72
Date:	29 November 2020
Institutions:	Medicine > Lehrstuhl für Pathologie
Identification Number:	Value Type 10.1007/s10585-020-10065-9 DOI
Keywords:	Sentinel lymph node; Metastases; Touch imprint cytology; Frozen section
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Yes
Item ID:	50607

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Abstract

Background An improved procedure that allows accurate detection of negative sentinel lymph node (SLN) and of SLN macrometastases during surgery would be highly desirable in order to protect patients from further surgery and to avoid unnecessary costs. We evaluated the accuracy of an intraoperative procedure that combines touch imprint cytology (TIC) and subsequent frozen section (FS) analysis. ...

Abstract

Background
An improved procedure that allows accurate detection of negative sentinel lymph node (SLN) and of SLN macrometastases during surgery would be highly desirable in order to protect patients from further surgery and to avoid unnecessary costs. We evaluated the accuracy of an intraoperative procedure that combines touch imprint cytology (TIC) and subsequent frozen section (FS) analysis. 2276 SLNs from 1072 patients with clinical node-negative early breast cancer were evaluated during surgery using TIC. Only cytologically-positive SLN were subsequently analysed with a single FS, preserving cytologically-negative SLN for the final postoperative histological diagnosis. Sensitivity, specificity and the accuracy of this approach were analysed by comparing the results from intra- and postoperative SLN and axillary node evaluation. This intraoperative method displayed 100% specificity for SLN metastases and was significantly more sensitive for prognostically relevant macrometastases (85%) than for micrometastases (10%). Sensitivity was highest for patients with two or more positive LNs (96%) than for those with only one (72%). 98% of the patients with final pN2a-pN3a were already identified during surgery. Patients who received primary axillary lymph node dissection had significantly more frequent metastases in further LNs (44.6%). Sensitivity was highest for patients with luminal-B, HER2+ and triple negative breast cancer and for any subtype if Ki-67 > 40%. TIC and subsequent FS of cytologically-positive SLNs is highly reliable for detection of SLN macrometastases, and allows accurate identification of patients with a high risk of extended axillary involvement during surgery, as well as accurate histological diagnosis of negative SLN.

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Metadata last modified: 27 Jun 2024 12:16

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