Breast Sentinel Lymph Node Frozen Section Practice: An Enterprise Audit as a Guide for Moving Forward.
* Context.--In recent years, there has been a shift to less aggressive surgical management of the axilla in breast cancer. Consequently, sentinel lymph node evaluation by frozen section (FS) has declined. Additionally, there has been an impetus to decrease efforts in identifying small sentinel lymph...
| Publicado en: | Archives of Pathology & Laboratory Medicine Vol. 145; no. 8; pp. 1018 - 1025 |
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| Autores principales: | , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
College of American Pathologists
Aug2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=151688066&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 151688066 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00039985 1FS jtl: Archives of Pathology & Laboratory Medicine issn: 00039985 maglogo: N pubinfo: dt: Aug2021 vid: 145 iid: 8 pid: 2550 pub: College of American Pathologists place: Northfield, Illinois artinfo: ui: 151688066 151688066 151688066 10.5858/arpa.2020-0411-OA 151688066 ppf: 1018 ppct: 7 formats: fmt: @attributes: type: P tig: atl: Breast Sentinel Lymph Node Frozen Section Practice: An Enterprise Audit as a Guide for Moving Forward. aug: au: Czaja, Rebecca Wu, Ruizhe Jorns, Julie M. affil: Department of Pathology, Medical College of Wisconsin, Milwaukee sug: subj: Breast Neoplasms Diagnosis Sentinel Lymph Node Biopsy Methods Frozen Sections Human Retrospective Design Academic Medical Centers Community Health Centers Sampling Error Axilla Surgery Neoplasm Metastasis Diagnosis ab: * Context.--In recent years, there has been a shift to less aggressive surgical management of the axilla in breast cancer. Consequently, sentinel lymph node evaluation by frozen section (FS) has declined. Additionally, there has been an impetus to decrease efforts in identifying small sentinel lymph node metastases. Objectives.--To critically evaluate our enterprise performance in evaluating axillary sentinel lymph nodes submitted for FS prior to considering changes in processing. Design.--A retrospective review (August 1, 2017-July 31, 2019) was conducted to identify sentinel and nonsentinel lymph nodes from 1 academic institution and 2 community sites. Cases were evaluated for grossing technique and discordance between FS and permanent section (PS) due to sampling and/or interpretive error. Clinicopathologic features were assessed. Results.--Lymph nodes from 426 patients with 432 neoplasms were sent for FS. Serial sectioning at 2-mm intervals was adhered to in 338 of 432 (78.2%). Serial sectioning was significantly lower at the community sites (14 of 60; 23.3%) versus at the academic institution (324 of 372; 87.1%; P < .001). Discordant cases were all false negatives (21 of 432; 4.8%). A total of 7 of 21 false negatives (33.3%) had macrometastatic (>2 mm) disease; of these, 3 were post--neoadjuvant chemotherapy, 3 were neither serially sectioned nor posttherapy, and 1 was a small (0.3-cm) focus. A total of 15 of 16 false negatives due to sampling error were detected on the first permanent section level. Conclusions.--Standard serial sectioning of sentinel lymph nodes at 2-mm intervals resulted in infrequent false negatives due to macrometastatic disease. A single additional permanent section level is reasonable, given adherence to serial sectioning. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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