The accuracy of intraoperative frozen section analysis of sentinel lymph nodes in patients with breast cancer

Abstract

Zafer Kilbas, Ramazan Yildiz, Erkan Ozturk, Mustafa Oner Mentes, Semih Gorgulu, Yusuf Peker

Background: The biopsy of sentinel lymph nodes (SLNs) has widely replaced conventional axillary lymph node dissection (ALND) for assessing the axillary lymph node (LN) status. Rapid intraoperative frozen section (FS) analysis of SLNs enables surgeon to perform ALND during the same operative procedure. However, there is an ongoing controversy regarding the accuracy and usefulness of FS for the evaluation of SLNs. The aim of the study was to investigate the accuracy of FS analysis in the management of patients with breast cancer. Patients and Methods: Between 2007 and 2014, 214 breast cancer patients who underwent SLN biopsy procedure with intraoperative FS were included in this retrospective study. The SLNs were examined using standard FS procedures, and each section was stained with hematoxylin and eosin (H and E) only. The remaining tissues were then further sectioned and examined with H and E postoperatively. The results of FS and permanent sections were compared (the sensitivity, specificity and accuracy of FS were calculated). Results: FS analysis detected LN metastases in 50 patients, while the permanent histopathologic examination detected metastases in another 9 patients. The sensitivity of FS for all kinds of metastases was 84.7%, but it reached up to 98% for macrometastases, and the specificity was 100%. FS allowed immediate completion of ALND in 50 patients (96%) with positive SLNs, and second-step surgery was only performed in 2 patients with discordant FS results. Conclusion: FS examination of SLNs is a reliable and safe procedure for the diagnosis of LN metastasis. FS provides immediate completion of ALND in case of metastatic disease in the SLNs