Fritzsche Florian Rudolf, Reineke Tanja, Morawietz Lars, Kristiansen Glen, Dietel Manfred, Fink Daniel, Rageth Christoph, Honegger Christoph, Caduff Rosmarie, Moch Holger, Varga Zsuzsanna
Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland.
Ann Surg Oncol. 2010 Nov;17(11):2892-8. doi: 10.1245/s10434-010-1097-x. Epub 2010 May 4.
Recommendations for intraoperative and postoperative breast sentinel lymph node (SLN) processing differ widely. Micrometastases and isolated tumor cells (ITC) have recently been proposed as prognostically and therapeutically relevant. We compared 3 SLN protocols with regard to intraoperative and postoperative diagnosis.
SLN in cohort I (270 patients) were intraoperatively assessed by stereomicroscopy. Intraoperative frozen section (IFS) was used only in stereomicroscopically suspicious SLN. In cohort II (197 patients), all SLN were examined with only 1 IFS. Final SLN workup in cohorts I and II consisted of complete step sectioning with immunohistochemistry. In cohort III (268 patients) 2 or more IFS were performed followed by 3 step sections and immunohistochemistry.
pN1 stages were significantly higher in cohorts I and II (33.3% and 34.0% respectively) than in cohort III (24.6%). Intraoperative false negativity for the detection of metastases (pN1) ranged from 54.4% (cohort I) and 35.8% (cohort II) to 21.2% (cohort III). In contrast, ITC were detected significantly more frequently in cohort I (9.3%) and cohort II (14.7%) than in cohort III (1.9%).
Higher rates of SLN metastases and ITC in cohort I/II compared to cohort III suggest that IFS may result in tissue loss thus increasing the risk of missing metastases. Sparse IFS but complete postoperative SLN workup with step sectioning and immunohistochemistry provides more accurate information regarding minimal disease in SLN, but often results in delayed axillary lymph node dissection. This is important for preoperative patient information and recommendations in SLN processing protocols.
术中及术后乳腺前哨淋巴结（SLN）处理的建议差异很大。微转移和孤立肿瘤细胞（ITC）最近被认为在预后和治疗方面具有相关性。我们比较了3种SLN方案在术中和术后诊断方面的情况。
队列I（270例患者）中的SLN在术中通过体视显微镜进行评估。仅对体视显微镜下可疑的SLN进行术中冰冻切片（IFS）检查。队列II（197例患者）中的所有SLN仅进行1次IFS检查。队列I和II中SLN的最终检查包括完整的连续切片及免疫组化。队列III（268例患者）进行2次或更多次IFS检查，随后进行3次连续切片及免疫组化。
队列I和II中的pN1分期（分别为33.3%和34.0%）显著高于队列III（24.6%）。检测转移灶（pN1）的术中假阴性率在队列I为54.4%，队列II为35.8%，队列III为21.2%。相比之下，队列I（9.3%）和队列II（14.7%）中ITC的检出率显著高于队列III（1.9%）。
与队列III相比，队列I/II中SLN转移和ITC的发生率更高，提示IFS可能导致组织丢失，从而增加漏诊转移灶的风险。IFS检查较少但术后对SLN进行完整的连续切片及免疫组化检查能提供关于SLN微小病变更准确的信息，但常导致腋窝淋巴结清扫延迟。这对于术前向患者提供信息以及在SLN处理方案中的建议很重要。
