scholarly journals Evaluation of the Benefit of Routine Intraoperative Frozen Section Analysis of Sentinel Lymph Nodes in Breast Cancer

ISRN Oncology ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
C. M. T. P. Francissen ◽  
R. F. D. van la Parra ◽  
A. H. Mulder ◽  
A. M. Bosch ◽  
W. K. de Roos
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Frozen Section ◽  
False Negative ◽  
False Negative Rate ◽  
Operation Time ◽  
Axillary Lymph ◽  
Negative Rate ◽  
Ablative Surgery ◽  
Negative Findings

Aims. Intraoperative analysis of the sentinel lymph node (SLN) by frozen section (FS) allows for immediate axillary lymph node dissection (ALND) in case of metastatic disease in patients with breast cancer. The aim of this study is to evaluate the benefit of intraoperative FS, with regard to false negative rate (FNR) and influence on operation time. Materials and Methods. Intraoperative analysis of the SLN by FS was performed on 628 patients between January 2005 and October 2009. Patients were retrospectively studied. Results. FS accurately predicted axillary status in 525 patients (83.6%). There were 78 true positive findings (12.4%), of which there are 66 macrometastases (84.6%), 2 false positive findings (0.3%), and 101 false negative findings (16.1%), of which there are 65 micrometastases and isolated tumour cells (64.4%) resulting in an FNR of 56.4%. Additional operation time of a secondary ALND after wide local excision and SLNB is 17 minutes, in case of ablative surgery 35 minutes. The SLN was negative in 449 patients (71.5%), making their scheduled operation time unnecessary. Conclusions. FS was associated with a high false negative rate (FNR) in our population, and the use of telepathology caused an increase in this rate. Only 12.4% of the patients benefited from intraoperative FS, as secondary ALND could be avoided, so FS may be indicated for a selected group of patients.

Validity of sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11023-11023
Author(s):  
H. Jinno ◽  
S. Asaga ◽  
M. Sakata ◽  
T. Kubota ◽  
M. Kitajima ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Cancer Patients ◽  
False Negative ◽  
False Negative Rate ◽  
Control Group ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Negative Rate

11023 Background: Sentinel lymph node biopsy (SLNB) is a potential alternative procedure to conventional axillary lymph node dissection (ALND) in clinically node-negative breast cancer patients. Neoadjuvant chemotherapy (NAC) is a standard of care for patients with locally advanced breast cancer and indications of NAC have been widespread to operable breast cancer patients to facilitate breast conserving surgery. However, the validity of SLNB in breast cancer patients who received NAC is still controversial. Methods: Forty-six patients with stage II or III breast cancer who were treated with NAC from January 2002 to May 2006 were included in the study. Consecutive 122 patients who had SLNB without NAC during the same period were used as a control group. All patients underwent SLNB followed by completion ALND. Sentinel lymph node (SLN) was detected using a combined method of injecting isosulfan blue dye and small-sized technetium- 99m-labeled tin colloid (particle size: 200–400 nm in diameter) peritumorally and subcutaneously. SLNs were evaluated by means of H&E and immunohistochemical staining. Results: SLNs were successfully identified in 42/46 patients (91.3%) treated with NAC and 112/113 patients (99.1%) without NAC (p=0.01). Metastases in the SLNs were found in 16/42 patients (38.1%) with NAC and 32/112 patients (28.6%) without NAC (p=0.2). There were 5 false negative cases (false negative rate: 23.8%) in the NAC group and 2 false negative cases (false negative rate: 5.9%) in the control group (p=0.05). Accuracy of SLNB in the NAC group was also significantly inferior to the control group (88.1% vs. 98.2%, p<0.01). The presence of clinically positive axillary lymph nodes before NAC was not correlated with false negative rate. Conclusions: These data suggest that NAC might be considered a contraindication to SLNB even in patients with clinically negative axillary lymph nodes before NAC. No significant financial relationships to disclose.

Sentinel Lymph Node Biopsy is a Reliable Method for Lymph Node Evaluation in Neoadjuvant Chemotherapy-treated Patients with Breast Cancer

2014 ◽  
Vol 80 (2) ◽  
pp. 171-177 ◽  
Author(s):  
Starr B. Koslow ◽  
Rachel E. K. Eisenberg ◽  
Queenie Qiu ◽  
Zhengming Chen ◽  
Alexander Swistel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
False Negative ◽  
False Negative Rate ◽  
Axillary Lymph ◽  
Extranodal Extension ◽  
Node Biopsy ◽  
Negative Rate

Sentinel lymph node (SLN) mapping in patients with breast cancer treated with neoadjuvant chemotherapy has been debated by surgeons as a result of potential compromise of lymphatic drainage. Whether clinicopathologic variables traditionally associated with SLN positivity differ in patients who have been treated with neoadjuvant chemotherapy has not been well studied. Patients diagnosed with breast carcinoma who underwent neoadjuvant chemotherapy, definitive breast surgery, sentinel node biopsy (SNB), and axillary lymph node dissection (ALND) were retrospectively identified over a 75-month period. Clinicopathologic parameters including age, clinical tumor and node stage, neoadjuvant chemotherapy regimen, pathological tumor and node stage, lymphovascular invasion (LVI), SLN and non-SLN involvement, and extranodal extension were recorded. Ninety-seven patients met inclusion criteria. Ninety-eight per cent had successful SLN mapping. Eight patients with negative SLNs had positive ALND (false-negative rate, 8.3%). Clinicopathological variables associated with SLN status included clinical axillary status ( P = 0.038), pathologic tumor size, and nodal status and LVI ( P < 0.001). Extranodal extension was significantly associated with non-SLN status ( P = 0.004). In patients achieving a pathologic complete response (PCR), SNB remained feasible and accurate (false-negative rate, 11.6%). Successful SLN mapping in patients who have undergone neoadjuvant chemotherapy is highly accurate with a low false-negative rate even in patients who have a PCR.

scholarly journals False-Negative Frozen Section of Sentinel Nodes in Early Breast Cancer Patients

2021 ◽  
Author(s):  
Zhu-Jun Loh ◽  
Kuo-Ting Lee ◽  
Ya-Ping Chen ◽  
Yao-Lung Kuo ◽  
Wei-Pang Chung ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Frozen Section ◽  
False Negative ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Frozen Sections ◽  
Sentinel Nodes ◽  
Tumor Emboli

Abstract Background: Sentinel lymph node biopsy (SLNB) is the standard approach of the axillary region for early breast cancer patients with clinically negative nodes. The present study investigated patients with false-negative sentinel nodes of intraoperative frozen section (FNSNs) in real-world data.Methods: A case–control study with a 1:3 ratio was conducted. FNSN was diagnosed when sentinel nodes (SNs) are negative in frozen sections but positive for metastasis in formalin-fixed paraffin-embedded (FFPE) sections. The control was defined as having no metastasis of SNs in both frozen and FFPE sections.Results: A total of 20 FNSN cases and 60 matched controls were enrolled from 333 SLNB patients between April 1, 2005, and November 31, 2009. The demographics and intrinsic subtypes of breast cancer were similar between FNSN and controls. The FNSN patients had larger tumor sizes in preoperative mammography (P = 0.033) and more lymphatic tumor emboli in core biopsy (P < 0.001). Four FNSN patients had metastasis in the non-relevant SNs. Another 16 FNSN patients had benign lymphoid hyperplasia of SNs in frozen sections and metastasis in the same SNs from the FFPE sections. Micrometastasis was detected in seven of 16 patients, and metastases in non-relevant SNs were recognized in two patients. All FNSN patients received a second operation with axillary lymph node dissection (ALND). After a median follow-up of 143 months, no FNSN patients developed recurrence of breast cancer. The disease-free survival, disease-specific survival, and overall survival in FNSN were not inferior to the controls.Conclusions: The patients with a larger tumor size and more lymphatic tumor emboli have a higher incidence of FNSN. However, outcomes of FNSN patients after completing ALND were noninferior to those without metastasis in SNs. ALND provides a correct diagnosis of patients with metastasis in non-sentinel axillary lymph nodes.

scholarly journals Preoperative Tumor Biopsy Results In More Detected Sentinel Node Than Intraoperative Biopsy In Breast Cancer Patients

2020 ◽  
Author(s):  
chenxi yuan ◽  
xinzhao wang ◽  
zhaoyun liu ◽  
chao li ◽  
mengxue bian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
False Negative ◽  
False Negative Rate ◽  
Excisional Biopsy ◽  
Breast Cancer Surgery ◽  
Tumor Biopsy ◽  
Tracer Injection ◽  
Negative Rate

Abstract Background Sentinel lymph node biopsy (SLNB) acts as a vital role in the breast cancer surgery, and the identified number of sentinel nodes determines its accuracy to represent the status of axillae. There remain two tumor biopsy modes in breast cancer, preoperative and intraoperative biopsy. We compared the effect of the two different biopsies on the result of SLNB. Methods Patients with clinical stage T1-3, N0 tumor were enrolled in this study. 53% received preoperative tumor biopsy and 47% received intraoperative excisional biopsy. For search of the sentinel lymph node, patients received dual tracer injection. The number of SLNs detected and false negative rate were compared between groups. Results 204 patients were enrolled, 108 received preoperative tumor biopsy and 96 received intraoperative excisional biopsy. Among all the patients, 160 received ALND following SLNB. Preoperative tumor biopsy detected more SLNs than intraoperative biopsy (mean rank 113.87 vs. 90.9, p= 0.004). False negative rate in preoperative and intraoperative tumor biopsy was 3% and 18%, respectively. Conclusions Patients in preoperative tumor biopsy group could find more SLNs than intraoperative biopsy patients. False negative rate was also lower in preoperative biopsy group.

scholarly journals Preoperative Tumor Biopsy Results In More Detected Sentinel Nodes Than Intraoperative Biopsy In Breast Cancer Patients

2020 ◽  
Author(s):  
chenxi yuan ◽  
xinzhao wang ◽  
zhaoyun liu ◽  
chao li ◽  
mengxue bian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
False Negative ◽  
False Negative Rate ◽  
Excisional Biopsy ◽  
Tumor Biopsy ◽  
Tracer Injection ◽  
Sentinel Nodes ◽  
Negative Rate

Abstract Background Sentinel lymph node biopsy (SLNB) acts as a vital role in the breast cancer surgery, and the identified number of sentinel nodes determines its accuracy to represent the status of axillae. There remain two tumor biopsy modes in breast cancer, preoperative and intraoperative biopsy. We compared the effect of the two different biopsies on the result of SLNB. Methods Patients with clinical stage T1-3, N0 tumor were enrolled in this study. 53% received preoperative tumor biopsy and 47% received intraoperative excisional biopsy. For search of the sentinel lymph node, patients received dual tracer injection. The number of SLNs detected and false negative rate were compared between groups. Results 204 patients were enrolled, 108 received preoperative tumor biopsy and 96 received intraoperative excisional biopsy. Among all the patients, 160 received ALND following SLNB. Preoperative tumor biopsy detected more SLNs than intraoperative biopsy (mean rank 113.87 vs. 90.9, p= 0.004). False negative rate in preoperative and intraoperative tumor biopsy was 3% and 18%, respectively. Conclusions Patients in preoperative tumor biopsy group could find more SLNs than intraoperative biopsy patients. False negative rate was also lower in preoperative biopsy group.

False negative rate of the highest radioactive count of sentinel lymph node in early stage breast cancer patients

The Breast ◽  
2019 ◽  
Vol 44 ◽  
pp. S105
Author(s):  
P. Chirappapha ◽  
R. Panawattanakul ◽  
W. Vassanasiri ◽  
Y. Kongdan ◽  
P. Lertsithichai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Cancer Patients ◽  
Early Stage ◽  
False Negative ◽  
False Negative Rate ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
Negative Rate

scholarly journals A Novel High-resolution Dedicated Axillary PET Improve Sensitivity in the Assessment of Regional Nodal Spread of Disease in Early Breast Cancer.

2020 ◽  
Author(s):  
Jingyi Cheng ◽  
Junjie Li ◽  
Guangyu Liu ◽  
Ruohong Shui ◽  
Sheng Chen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
High Resolution ◽  
Breast Carcinoma ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Axillary Lymph Node ◽  
False Negative ◽  
False Negative Rate ◽  
Axillary Lymph

Abstract Background: The aim of this study was to assess if a novel high-resolution dedicated axillary lymph node Positron Emission Tomography (LymphPET) system could improve sensitivity analysing Lymph Node involvement in early breast carcinoma with clinical N0-N1 stage. Methods: A total of 103 patients with clinical stage of T1-2N0-1M0 breast cancer were evaluated with LymphPET. The maximum single-voxel PET uptake value of Axillary Lymph Node (maxLUV) and the tumor-to-background ratio (TBR) for fat (TBR1) and muscle (TBR2) tissue were calculated. Then, seventy-eight patients with cN0 stage received sentinel lymph node biopsy (SLNB) alone or in combination with ALN dissection (ALND) and 25 patients with cN1 stage underwent fine-needle aspiration (FNA). Results: Ninety-nine invasive breast carcinoma entered this study. The diagnostic sensitivity of LymphPET was 87.80%, specificity was 79.31%, false-negative rate was 12.20%, false-positive rate was 20.69%, positive predictive value was 75.00%, negative predictive value was 90.20%, and accuracy was 82.83%. The maxLUV was superior to TBR1 and TBR2 in the detection of ALN, with 0.27 being the most optimal cutoff value. Conclusion: The 18F-FDG LymphPET could be used to identify and recognize more indolent ALNs of the breast cancer because of more sensitivity and much higher negative predictive value.

Re-Evaluate the Value of Frozen Sections in Diagnoses of Breast Malignancies that Failed to be Diagnosed by Core Needle Biopsy: A Chinese Retrospective Analysis of Clinical Practice

2021 ◽  
Author(s):  
Jialei Xue ◽  
Jianwei Li ◽  
Yue Gong ◽  
Qiuxia Cui ◽  
Li Dai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Frozen Section ◽  
False Negative ◽  
False Negative Rate ◽  
Frozen Sections ◽  
Core Needle ◽  
Negative Rate ◽  
Breast Malignancies

Abstract Objective: The value of frozen sections in diagnoses of breast malignancies that failed to be diagnosed by core needle biopsy (CNB) is indeterminate. To re-evaluate and improve the utility of frozen section on this kind of breast malignancy, we conducted a retrospective data analysis and constructed a prediction model.Method: We reviewed data of breast cancer patients that failed to be diagnosed by CNB (CNB-undiagnosable) in Fudan University Shanghai Cancer Center (FUSCC) from May 1, 2006 to December 31, 2019. Clinical characteristics of patients were collected. the correlation between clinical features and false negative rate (FNR) of frozen sections was explored with logistic regression analysis, after which a nomogram was constructed to predict the probability of false negative.Result: The diagnostic sensitivity of frozen section on CNB-undiagnosable breast cancer was 67.18%, and the FNR was 32.82%. In multivariate analysis, papillary lesion (OR, 4.251; 95% CI, 2.804-6.492; P<0.0001) and sclerosing adenosis (OR, 3.727; 95% CI, 1.897-7.376; P= 0.0001) on CNB were risk factors of false negative, while clustered microcalcifications on mammography (OR, 0.345; 95% CI, 0.216-0.543; P < 0.0001) and ultrasonic BI-RADS category 4C-5 (OR, 0.250; 95% CI, 0.081-0.777; P = 0.0157) were favorable factors of true positive. The false negative rate of frozen section could be controlled at about 10% by the prediction of nomogram. Conclusion: Frozen sections are valuable in the diagnosis of CNB-undiagnosable breast cancers. It is recommended to implement the intraoperative frozen sections for high-risk breast lesions with a low probability of false negative indicated by prediction, so as to minimize the occurrence of unnecessary re-operation.

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