Division of Surgery, Diakonessen Hospital, Utrecht, The Netherlands.
Ann Surg Oncol. 2010 Oct;17(10):2690-5. doi: 10.1245/s10434-010-1052-x. Epub 2010 Apr 27.
In breast cancer surgery, intraoperative frozen section (FS) analysis of sentinel lymph nodes (SLNs) enables axillary lymph node dissection (ALND) during the same operative procedure. In case of discordance between a "negative" FS analysis and definitive histology, an ALND as a second operation is advocated since additional lymph node metastases may be present. The clinical implications of the subsequent ALND in these patients were evaluated.
Between November 2000 and May 2008, 879 consecutive breast cancer patients underwent surgery including sentinel lymph node biopsy (SLNB) with intraoperative FS analysis of 2 central cuts from axillary SLNs. Following fixation and serial sectioning, SLNs were further examined postoperatively with hematoxylin and eosin (H&E) and immunohistochemical techniques. For patients with a discordant FS examination, the effect of the pathology findings of the subsequent ALND specimen on subsequent nonsurgical therapy were evaluated.
FS analysis detected axillary metastases in the SLN(s) in 200 patients (23%), while the definitive pathology examination detected metastases in SLNs in another 151 patients (17%). A complementary ALND was performed in 108 of the 151 patients with discordant FS. Additional tumor positive axillary lymph nodes were found in 17 patients (16%), leading to "upstaging" in 7 (6%). Subsequent nonsurgical treatment was adjusted in 4 patients (4%): all 4 had more extensive locoregional radiotherapy; no patient received additional hormonal and/or chemotherapy.
Discordance between intraoperative FS analysis and definitive histology of SLNs is common. In this selection of patients, a substantial proportion had additional lymph node metastases, but postsurgical treatment was rarely adjusted based on the findings of the complementary ALND.
在乳腺癌手术中，术中冷冻切片（FS）分析前哨淋巴结（SLN）可在同一手术过程中进行腋窝淋巴结清扫术（ALND）。如果“阴性”FS 分析与明确的组织学结果不一致，则主张进行第二次 ALND，因为可能存在其他淋巴结转移。评估了这些患者随后进行 ALND 的临床意义。
在 2000 年 11 月至 2008 年 5 月期间，879 例连续的乳腺癌患者接受了手术，包括前哨淋巴结活检（SLNB）和术中 FS 分析，对 2 个腋窝 SLN 的 2 个中央切进行分析。固定和连续切片后，使用苏木精和伊红（H&E）和免疫组织化学技术进一步检查 SLN。对于 FS 检查结果不一致的患者，评估随后的 ALND 标本的病理学发现对非手术治疗的影响。
FS 分析在 200 例（23%）患者的 SLN 中检测到腋窝转移，而明确的病理学检查在另外 151 例（17%）患者的 SLN 中检测到转移。在 151 例 FS 结果不一致的患者中，有 108 例行补充 ALND。在 17 例患者（16%）中发现了额外的肿瘤阳性腋窝淋巴结，导致 7 例（6%）分期升级。随后调整了 4 例（4%）非手术治疗：所有 4 例患者接受了更广泛的局部区域放疗；没有患者接受额外的激素和/或化疗。
术中 FS 分析与 SLN 明确组织学之间的不一致很常见。在这组患者中，很大一部分患者有额外的淋巴结转移，但根据补充 ALND 的结果，很少调整术后治疗。
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