Intraoperative Frozen Section Assessment of Sentinel Lymph Nodes in Breast Cancer: Six-Year Experience in a Tertiary Hospital
Keywords:sentinel node biopsy, breast cancer, axillary lymph node dissection
Objective. To determine the reliability of intraoperative frozen section (FS) assessment of sentinel lymph nodes (SLN) in breast cancer patients and describe the factors affecting its evaluation.
Methodology. Records of 245 breast cancer patients with FS of SLNs from December 2007 to December 2013 were retrieved and analyzed. The effect of discordant FS examination and pathology findings on axillary lymph node dissection (ALND) was then evaluated.
Results. Of the total 616 SLNs evaluated, 85 (13.80%) SLNs were positive on FS, with the majority having a histological diagnosis of invasive ductal carcinoma of no special type (62.04%). Overall identification rate was 98.36%. Frozen section biopsies had good correlation with permanent sections, with a sensitivity (Sn) of 92.39%, specificity (Sp) of 100%, and a positive predictive value (PPV) of 100%. Negative cases on FS but were found positive on permanent sections were all cases of micrometastases, giving a false negative rate of 1.31% and negative predictive value (NPV) of 98.68%. Validation with ALND showed Sn of 100%, Sp of 50%, NPV of 100%, and PPV of 37.17%.
Conclusion. The 6 year data on intraoperative FS reliably evaluated the SLN status of breast cancer patients with a negligible false negative rate. Factors affecting its effectiveness include the predictors of nodal involvement, multilevel sectioning, and size of metastases.
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