Weiser M R, Montgomery L L, Susnik B, Tan L K, Borgen P I, Cody H S
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Ann Surg Oncol. 2000 Oct;7(9):651-5. doi: 10.1007/s10434-000-0651-3.
Routine intraoperative frozen section (FS) of sentinel lymph nodes (SLN) can detect metastatic disease, allowing immediate axillary dissection and avoiding the need for reoperation. Routine FS is also costly, increases operative time, and is subject to false-negative results. We examined the benefit of routine intraoperative FS among the first 1000 patients at Memorial Sloan Kettering Cancer Center who had SLN biopsy for breast cancer.
We performed SLN biopsy with intraoperative FS in 890 consecutive breast cancer patients, none of whom had a back-up axillary dissection planned in advance. Serial sections and immunohistochemical staining for cytokeratins were performed on all SLN that proved negative on FS. The sensitivity of FS was determined as a function of (1) tumor size and (2) volume of metastatic disease in the SLN, and the benefit of FS was defined as the avoidance of a reoperative axillary dissection.
The sensitivity of FS ranged from 40% for patients with Tla to 76% for patients with T2 cancers. The volume of SLN metastasis was highly correlated with tumor size, and FS was far more effective in detecting macrometastatic disease (sensitivity 92%) than micrometastases (sensitivity 17%). The benefit of FS in avoiding reoperative axillary dissection ranged from 4% for Tla (6 of 143) to 38% for T2 (45 of 119) cancers.
In breast cancer patients having SLN biopsy, the failure of routine intraoperative FS is largely the failure to detect micrometastatic disease. The benefit of routine intraoperative FS increases with tumor size. Routine FS may not be indicated in patients with the smallest invasive cancers.
前哨淋巴结（SLN）的术中常规冰冻切片（FS）可检测转移性疾病，从而能立即进行腋窝清扫并避免再次手术。常规FS成本高、增加手术时间且可能出现假阴性结果。我们在纪念斯隆凯特琳癌症中心对首批1000例因乳腺癌接受SLN活检的患者进行了常规术中FS获益情况的研究。
我们对890例连续的乳腺癌患者进行了术中FS的SLN活检，这些患者均未预先计划进行备用腋窝清扫。对所有FS结果为阴性的SLN进行系列切片及细胞角蛋白免疫组化染色。FS的敏感性根据（1）肿瘤大小和（2）SLN中转移灶的体积来确定，FS的获益定义为避免再次进行腋窝清扫手术。
FS的敏感性范围为T1a期患者为40%，T2期癌症患者为76%。SLN转移灶的体积与肿瘤大小高度相关，FS检测大转移灶（敏感性92%）比微转移灶（敏感性17%）有效得多。FS在避免再次腋窝清扫手术方面的获益范围为T1a期（143例中的6例）为4%，T2期（119例中的45例）为38%。
在接受SLN活检的乳腺癌患者中，常规术中FS的失败主要是未能检测到微转移灶。常规术中FS的获益随肿瘤大小增加。对于最小的浸润性癌患者，可能无需常规FS。
