Lerttiendamrong Bhoowit, Treeratanapun Nattanan, Vacharathit Voranaddha, Tantiphlachiva Kasaya, Vongwattanakit Phuphat, Manasnayakorn Sopark, Vongsaisuwon Mawin
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Breast Cancer (Dove Med Press). 2022 Sep 19;14:281-290. doi: 10.2147/BCTT.S380579. eCollection 2022.
Clinical application of the ACOSOG Z0011 trial results allows clinically node-negative breast cancer patients who meet criteria to avoid axillary dissection even when 1-2 sentinel lymph nodes (SLNs) are positive for metastatic disease. Intraoperative frozen section (iFS) analyses of SLNs were thought to reduce re-operation rates despite variable reported sensitivity and possibility of a false negative result. This study evaluated the rate of re-operations prevented by SLN iFS in a tertiary care hospital in Bangkok, Thailand, over a 6-year time-frame.
From April 2016 to April 2022, 1284 sentinel lymph node biopsy (SLNB) procedures were performed. Of these, 214 cases were breast-conserving surgery in accordance with the ACOSOG criteria with concomitant usage of iFS. Clinicopathological features of these cases were collected and analyzed. Re-operation rates prevented by the additional intervention were reported.
Only five additional operations were prevented with the usage of 214 iFS. The discordance rate between frozen and permanent sections in terms of presence of metastatic disease and number of total lymph nodes was around 15%. Tumor staging, node staging, Nottingham histologic grading and lymphovascular invasion are significant predictors of SLN metastasis.
iFS results in a very low prevention rate for follow-up ALND in patients with preoperative clinically negative axillary nodes and is associated with a non-negligible discordance rate with permanent sections. Our study suggests iFS may be avoided in most cases of early-stage clinically and radiographically node-negative breast cancer patients. Doing so may reduce surgical costs and total operative time without a significant impact on the overall quality of treatment and standard of care.
美国外科医师学会肿瘤学组（ACOSOG）Z0011试验结果的临床应用，使符合标准的临床腋窝淋巴结阴性乳腺癌患者即使1 - 2枚前哨淋巴结（SLN）存在转移癌，也可避免腋窝清扫。尽管术中冰冻切片（iFS）对SLN的分析报告的敏感性各异且存在假阴性结果的可能性，但人们认为其可降低再次手术率。本研究评估了泰国曼谷一家三级医院在6年时间内，SLN的iFS预防再次手术的发生率。
2016年4月至2022年4月期间，共进行了1284例前哨淋巴结活检（SLNB）手术。其中，214例为符合ACOSOG标准的保乳手术，并同时使用了iFS。收集并分析这些病例的临床病理特征。报告额外干预预防的再次手术率。
使用214次iFS仅预防了5例额外手术。在转移癌的存在及总淋巴结数量方面，冰冻切片与永久切片之间的不一致率约为15%。肿瘤分期、淋巴结分期、诺丁汉组织学分级和淋巴管浸润是SLN转移的重要预测因素。
对于术前临床腋窝淋巴结阴性的患者，iFS预防后续腋窝淋巴结清扫（ALND）的发生率非常低，且与永久切片的不一致率不可忽视。我们的研究表明，在大多数早期临床和影像学腋窝淋巴结阴性的乳腺癌患者中，可能可避免使用iFS。这样做可降低手术成本和总手术时间，而对整体治疗质量和护理标准无显著影响。
