title: Intraoperative examination of sentinel nodes in breast cancer: is the glass half full or half empty?
abstract: BACKGROUND
  Intraoperative identification of positive sentinel lymph nodes in patients with breast cancer may avoid a return to the operating room.
  
  
  METHODS
  In a group of 402 consecutive patients with primary breast cancer who underwent sentinel lymph node biopsy, an intraoperative examination (IE) was obtained in 236 cases either by frozen section (FS; n = 68) or by touch preparation cytology (TP; n = 168).
  
  
  RESULTS
  IE had an accuracy of 89% (209 of 236), but it identified only 52 of 77 positive cases (sensitivity, 68%). There were 25 false-negative cases (13.7%), of which 7 were macrometastases and 18 by micrometastases (P < .001). Six macrometastases were missed by TP and one by FS (P = .9). There were two false-positive cases (3.7%). Overall, 48 (20%) of 236 patients avoided a delayed return to the operating room for a completion lymphadenectomy because of IE findings. This occurred in 10% of patients with tumors <1 cm in diameter, in 20% of those with tumors between 1 and 2 cm, and in 34% of those with tumors >2 cm in diameter (P = .05). The cost savings for the Italian Health System amounted to 198,040 (US$223,794) in these patients.
  
  
  CONCLUSIONS
  IE has acceptable sensitivity for lymph node macrometastases, but it is a weak tool for diagnosing micrometastases. FS and TP are roughly equivalent. IE allows management changes, because approximately 20% of all patients are expected to undergo synchronous axillary dissection, and it is particularly helpful in T2 patients. This may allow substantial cost savings for the health-care system.
authors.affiliation: Departments of General amd Surgical Oncology, Ospedale MG Vannini, Via Acqua Bullicante 4, 00177 Rome, Italy. lfortunato@tiscali.it
authors.forename: Lucio
authors.initials: L
authors.lastname: Fortunato
authors.forename: Mostafà
authors.initials: M
authors.lastname: Amini
authors.forename: Massimo
authors.initials: M
authors.lastname: Farina
authors.forename: Simonetta
authors.initials: S
authors.lastname: Rapacchietta
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Costarelli
authors.forename: Francesca R
authors.initials: FR
authors.lastname: Piro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Alessi
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Pompili
authors.forename: Salvatore
authors.initials: S
authors.lastname: Bianca
authors.forename: Carlo Eugenio
authors.initials: CE
authors.lastname: Vitelli
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007432:Intraoperative Period; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy