Axillary Lymph Node Status in Breast Cancer by Frozen Section Diagnosis.
Jorge A Thome, Carlos F Mendiburu, Fabio MC Palma, Antonio R Moriel, Agnes R Fett-Conte. Rio Preto Medical School,, São José do Rio Preto, Sao Paulo, Brazil; Institute of Pathology and Cytopathology, São José do Rio Preto, Sao Paulo, Brazil; Rio Preto Medical School, São José do Rio Preto, Sao Paulo, Brazil
Background: Intra-operative frozen section analysis (FS) has become a routine procedure to evaluate the status of axillary lymph nodes in breast cancer. A retrospective study was carried out in our institution to evaluate the accuracy and sensitivity of FS.
Design: We compared FS results with the final pathological diagnosis. Three sections cut at 150-µm intervals from fresh sentinel lymph node specimens (LNS) (2 mm thick) were analyzed by FS. Postoperative histology (hematoxylin-eosin and immunohistochemistry) was performed on other sections. The results of 177 LNS from women with breast carcinoma were reviewed.
Results: Metastases were detected in 22 (12%) of the SLN. FS detected 13 macrometastases and 1 micrometastase. Another 8 micrometastases were found (3 by immunohistochemistry) among cases of negative frozen sections in the postoperative analysis. FS diagnosis data proved to have an overall accuracy of 95%, sensitivity of 64% and specificity of 100%. The accuracy and sensitivity of FS were suboptimal for the detection of micrometastases.
Conclusions: Our results show that FS is highly accurate and sensitive to detect macrometastases, but fails to detect micrometastases. More sections need to be analyzed to increase the sensitivity for metastases smaller than 2 mm and negative FS results should be confirmed in postoperative analysis. The use of immunohistochemistry improves micrometastase detection and can be used in the analysis of permanent sections.
Monday, February 28, 2011 1:00 PM
Poster Session II # 29, Monday Afternoon