Intraoperative examination of sentinel lymph nodes by ultrarapid immunohistochemistry in breast cancer.
BACKGROUND
The ultrarapid immunohistochemistry (IHC) technique was applied to the intraoperative examination of sentinel lymph nodes (SLNs) because routine SLN frozen section examinations sometimes produce false-negative results. The present study was undertaken to develop a reliable protocol for the ultrarapid IHC of SLNs.


METHODS
SLNs from 79 breast cancer patients with clinically negative axillary node were examined intraoperatively by frozen hematoxylin-eosin (H&E) stain and by ultrarapid cytokeratin IHC assay. On the basis of the result of serially sectioned permanent study, the sensitivity and accuracy of each intraoperative technique were compared.


RESULTS
The total number of dissected SLNs was 178 with a mean of 2.3 (1-5) per patient. The mean turnaround time for ultrarapid IHC was 20 min. The sensitivity rates of frozen H&E staining and ultrarapid IHC were 70.0 and 85.0%, respectively (P = 0.083). Each method had a specificity of 100%. The accuracy rates for frozen H&E staining and rapid IHC were 92.4 and 96.2%, respectively (P = 0.083). Ultrarapid IHC detected one additional patient with sentinel node micrometastasis and two additional patients with isolated tumor cells (ITCs). In those patients, two underwent completion axillary dissection simultaneously and could avoid a second operation.


CONCLUSIONS
Ultrarapid cytokeratin IHC enhanced the intraoperative detection of sentinel node micrometastasis and ITCs in breast cancer without consuming much time. In patients who need completion axillary dissection after sentinel node biopsy, this technique could be helpful in avoiding a second operation.
Choi
Young Jin
YJ
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul 135-710, Korea. jhyang@smc.samsung.co.kr.
Yun
Hae Ran
HR
Yoo
Ki Eun
KE
Kim
Jung Han
JH
Nam
Seok Jin
SJ
Choi
Yoon La
YL
Ko
Young Hyeh
YH
Kim
Byung Tae
BT
Yang
Jung-Hyun
JH
D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D007430:Intraoperative Care; D007633:Keratins / Q000032:analysis; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy
D007633:Keratins