Chan Sharon Wing-wai, LaVigne Katherine A, Port Elisa R, Fey Jane V, Brogi Edi, Borgen Patrick I, Cody Hiram S
Department of Surgery, United Christian Hospital, Kowloon, Hong Kong, China.
Ann Surg. 2008 Jan;247(1):143-9. doi: 10.1097/SLA.0b013e3181581f41.
Although many questions regarding sentinel lymph node (SLN) biopsy in breast cancer have been answered by observational studies and, increasingly, by prospective trials, the role of intraoperative SLN assessment remains a matter of debate. Here we report in detail the results of intraoperative SLN assessment by frozen section (FS), with particular attention to variations in sensitivity and yield by histologic subtype, by tumor size, and by other clinicopathologic parameters.
Five thousand two hundred ninety-eight consecutive patients with clinical stage T1-3N0 invasive breast carcinoma had SLN biopsy with intraoperative FS at Memorial Sloan Kettering Cancer Center between 1996 and 2004. We report the results of FS by sensitivity (the proportion of all positive SLN detected by FS) and by yield (the proportion of all FS procedures in which the FS was positive).
The sensitivity of FS was 61% overall, was higher for invasive duct (ID) than for invasive lobular (IL) cancers (62% vs. 52%; P = 0.006), and was marginally lower for favorable subtypes (46%; P = 0.26). The yield of FS was 21% overall, with no difference between ID and IL cancers (22% vs. 21%; P = 0.49), and with a substantially lower yield for favorable subtypes (3%; P < 0.001). The yield of FS increased with tumor size for ID and IL cancers (P < 0.001), but not for favorable subtypes. For both ID and IL cancers, the sensitivity and yield of FS were significantly higher with younger patient age, increasing tumor size, and lymphovascular invasion. The yield of FS was <10% for all patients with ID or IL tumors < or =1 cm in size who were older than 60 years of age. Among all FS-positive patients, only 45% were identified by the first FS, whereas 91% were cumulatively identified by the first, second, or third FS.
For patients with ID and IL cancers, the overall sensitivity of FS is >50%, but the yield of FS is <10% for individuals > or =60 years of age with T1a/b tumors. Intraoperative FS may not be worthwhile for this low-yield subset, especially for patients with invasive breast cancer of favorable type.
尽管关于乳腺癌前哨淋巴结（SLN）活检的许多问题已通过观察性研究以及越来越多的前瞻性试验得到解答，但术中SLN评估的作用仍存在争议。在此，我们详细报告术中通过冰冻切片（FS）评估SLN的结果，特别关注不同组织学亚型、肿瘤大小及其他临床病理参数在敏感性和检出率方面的差异。
1996年至2004年期间，在纪念斯隆凯特琳癌症中心，5298例连续的临床分期为T1 - 3N0的浸润性乳腺癌患者接受了术中FS的SLN活检。我们通过敏感性（FS检测出的所有阳性SLN的比例）和检出率（FS结果为阳性的所有FS操作的比例）报告FS的结果。
FS的总体敏感性为61%，浸润性导管癌（ID）的敏感性高于浸润性小叶癌（IL）（62%对52%；P = 0.006），预后良好亚型的敏感性略低（46%；P = 0.26）。FS的总体检出率为21%，ID癌和IL癌之间无差异（22%对21%；P = 0.49），预后良好亚型的检出率显著更低（3%；P < 0.001）。ID癌和IL癌的FS检出率随肿瘤大小增加（P < 0.001），但预后良好亚型并非如此。对于ID癌和IL癌，患者年龄越小、肿瘤越大以及存在淋巴管浸润时，FS的敏感性和检出率显著更高。年龄大于60岁、肿瘤大小≤1 cm的所有ID或IL肿瘤患者，FS的检出率<10%。在所有FS阳性患者中，仅45%由首次FS检出，而91%由首次、第二次或第三次FS累计检出。
对于ID癌和IL癌患者，FS的总体敏感性>50%，但对于年龄≥60岁、肿瘤为T1a/b的患者，FS的检出率<10%。对于这个低检出率亚组，术中FS可能不值得，特别是对于预后良好类型的浸润性乳腺癌患者。
