Gupta Sandhya, Kadayaprath Geeta, Ambastha Rooma, Shrivastava Shakti Saumnam
Breast Unit, Department of Surgical Oncology, MICC, New Delhi, India.
Department of Pathology, MICC, New Delhi, India.
Indian J Surg Oncol. 2022 Jun;13(2):312-315. doi: 10.1007/s13193-021-01458-7. Epub 2021 Oct 5.
Sentinel lymph node biopsy is an established practice to avoid axillary clearance, in clinically negative axilla, in breast cancer patients. Sentinel nodes harvested by dual technique, if found negative on intraoperative frozen section, can prevent breast cancer patient from a potentially debilitating complete axillary clearance. Hence, analyzing the institutional accuracy of this technique and comparing it with international standards, becomes important in providing optimal treatment to these patients. A retrospective analysis of all patients who had undergone sentinel lymph node biopsy at our institute from December 2014 to December 2018 was carried out. At our institute, sentinel lymph nodes are identified using dual technique of methylene blue and radiocolloid dye. Intraoperative frozen section of these hot or blue or any enlarged nodes is performed. Patients with positive frozen section undergo complete axillary clearance. All frozen and unfrozen biopsy material is subjected to further paraffin sectioning and immunohistochemistry. False negative rate and factors associated with were analyzed. A total number of 424 patients had undergone intraoperative frozen section for the sentinel node in breast cancer at our institute during the study period. Among these, 307 patients had negative sentinel nodes and 117 had positive sentinel nodes of frozen section. Seventeen patients out of 307 had lymph node metastases in final paraffin report (false negative rate = 12.6%). Two of these were found to have macrometastasis, 13 had micrometastasis and 2 had isolated tumor cells on final immunohistochemistry report. Size of metastases to sentinel lymph node was found to be a statistically significant contributor to higher false negative rate. Sentinel lymph node biopsy using intraoperative frozen section, is a sensitive and specific technique of staging axilla in breast cancer patients. Detection of micrometastasis and isolated tumor cells present a technical challenge and are associated with higher false negative rates.
前哨淋巴结活检是一种既定的做法，用于避免在乳腺癌患者临床腋窝阴性的情况下进行腋窝清扫。通过双重技术获取的前哨淋巴结，如果术中冰冻切片结果为阴性，则可使乳腺癌患者避免进行可能导致身体衰弱的完整腋窝清扫。因此，分析该技术在机构内的准确性并与国际标准进行比较，对于为这些患者提供最佳治疗至关重要。对2014年12月至2018年12月在本机构接受前哨淋巴结活检的所有患者进行了回顾性分析。在本机构，使用亚甲蓝和放射性胶体染料的双重技术来识别前哨淋巴结。对这些热结节、蓝色结节或任何肿大的结节进行术中冰冻切片。冰冻切片阳性的患者进行完整的腋窝清扫。所有冰冻和未冰冻的活检材料都进行进一步的石蜡切片和免疫组织化学检查。分析假阴性率及其相关因素。在研究期间，本机构共有424例乳腺癌患者接受了前哨淋巴结的术中冰冻切片检查。其中，307例患者的前哨淋巴结为阴性，117例患者的冰冻切片前哨淋巴结为阳性。307例患者中有17例在最终石蜡报告中出现淋巴结转移（假阴性率 = 12.6%）。在最终免疫组织化学报告中，其中2例为大转移，13例为微转移，2例为孤立肿瘤细胞。前哨淋巴结转移灶的大小被发现是导致较高假阴性率的一个统计学显著因素。使用术中冰冻切片的前哨淋巴结活检是乳腺癌患者腋窝分期的一种敏感且特异的技术。微转移和孤立肿瘤细胞的检测存在技术挑战，且与较高的假阴性率相关。
