Touch Preparations for Intraoperative Diagnosis of Sentinel Lymph Nodes after Neoadjuvant Therapy for Breast Cancer Have a High False Negative Rate
Robin M Elliott, Robert R Shenk, Hannah L Gilmore. University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
Background: Intraoperative analysis of sentinel lymph nodes (SLNs) for breast cancer has been a common request by surgeons over the past decade because an axillary lymph node dissection (ALND) was done at the time of surgery in patients with a positive result. Touch preparation (TP) has become a preferred method by many pathologists because of reported high sensitivities and rapid turnaround time. However, prior studies looking at the sensitivity and specificity of TP for SLN diagnosis have not been performed on patients who have had prior therapy. There is increasing data that the use of SLN biopsy in patients after neoadjuvant therapy is accurate and results in the sparing of the axilla for a significant number of patients. However, after treatment, many of these SLN have significant treatment changes including extensive fibrosis that may impact the intraoperative assessment by TP for diagnosis.
Design: Surgical pathology records from 2011 were searched for all intraoperative evaluations of SLNs by TP on patients who had received neoadjuvant therapy. The results from the intraoperative diagnosis were compared with the final pathology reports to determine the rate of concordance and discordance.
Results: Overall, there were a total of 58 sentinel lymph nodes from 23 different patients that were evaluated by TP intraoperatively. Of the 51 SLNs that were negative intraoperatively by TP, 12 (24%) were actually positive on permanent sections. There was 1 SLN that had suspicious cells that was positive on permanents. All 6 SLNs that were positive on TP were also positive on permanents. Overall, 6 of 23 patients (26%) had at least one discordant result. Notably, of the 18 patients who had negative SLNs by TP intraoperatively, 10 went on to have an ALND at the time of surgery despite the negative result, and 1 patient with a positive review at the time of surgery did not go on to ALND.
Conclusions: The use of TP for the diagnosis of malignancy in SLNs after neoadjuvant therapy has significant limitations and results in a high false negative rate. Intraoperative diagnosis of SLN should be used only in those cases where a positive result truly will determine the need for ALND at the time of surgery, and additional sampling by frozen section should be considered to improve the accuracy of intraoperative diagnosis.
Category: Quality Assurance
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 279, Tuesday Morning