title: Intraoperative pathologic evaluation of a breast cancer sentinel lymph node biopsy as a determinant for synchronous axillary lymph node dissection.
abstract: BACKGROUND
  Intraoperative pathologic evaluation of a breast cancer sentinel lymph node (SLN) biopsy permits synchronous axillary lymph node dissection (ALND), but frozen section is time consuming and potentially inaccurate. This study evaluated intraoperative gross examination and touch prep analysis (TPA) of a breast cancer SLN biopsy as determinants for synchronous ALND.
  
  
  METHODS
  Intraoperative gross examination/TPA were performed on the SLN of consecutive breast cancer patients from 1997 to 2000. Patients with an intraoperative "positive" SLN underwent synchronous ALND. Intraoperative results were compared with the final pathology.
  
  
  RESULTS
  Thirty-seven of 150 patients had a positive SLN on final pathology. Intraoperative gross examination/TPA identified 54% (20 of 37) of these patients. All intraoperative "positive" patients underwent synchronous ALND. Of 17 "false-negative" findings, 53% (9 of 17) had micrometastatic disease. There were no "false-positive" results. Overall sensitivity and specificity were 54% and 100%, respectively.
  
  
  CONCLUSIONS
  Gross examination/TPA are simple, rapid techniques for the intraoperative evaluation of a breast cancer SLN. As there were no false-positive results, the rationale behind SLN biopsy was preserved. These techniques permitted synchronous ALND in over half of all patients with a positive SLN. This represents a potential benefit to the patient by eliminating a second hospitalization for delayed ALND.
authors.affiliation: Division of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Kane
authors.forename: S B
authors.initials: SB
authors.lastname: Edge
authors.forename: J S
authors.initials: JS
authors.lastname: Winston
authors.forename: N
authors.initials: N
authors.lastname: Watroba
authors.forename: T C
authors.initials: TC
authors.lastname: Hurd
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D021701:Sentinel Lymph Node Biopsy