title: A standardized sentinel lymph node enhanced pathology protocol (SEPP) in patients with breast cancer.
abstract: OBJECTIVE
  Sentinel lymph node (SLN) biopsy allows enhanced pathology with serial sections and immunohistochemical analysis of the retrieved node. We present our experience with a simple, practical, pathology protocol.
  
  
  METHODS
  We analysed 416 consecutive breast cancer patient who underwent SLN biopsy. These were studied with six couples of sections at three different levels, each stained with hematoxylin-eosin (H/E) and immunohistochemistry (IHC) (MNF 116).
  
  
  RESULTS
  With conventional analysis the SLN was positive in 106/416 cases (25%). The addition of serial sections, according to the protocol, allowed diagnoses of micrometastases (MICRO) (n = 22) or isolated tumor cells (ITC) (n = 38) or MICRO (n = 1) in 51/416 patients (14.6%). Specifically, the diagnosis was undertaken at level I (8.9%), level II (4%), or level III (1,6%). The incidence of MICRO or ITC was not different in T1 and T2 cases (13% vs. 15%, P = 0.7). The addition of the third level of analysis added very little both in T1 and T2 cancers (1.3% vs. 3.8%, P = 0.1).
  
  
  CONCLUSIONS
  Serial sectioning of the SLN allows diagnosis of MICRO and ITC in a significant percentage of cases. Adoption of our protocol seems practical, as the incidence of level III positivity is extremely low, particularly in T1 cancers, and additional sections would be, therefore, unlikely useful.
authors.affiliation: Department of Surgery, San Giovanni-Addolorata Hospital, Via Amba Aradam 9, Rome, Italy. lfortunato@hsangiovanni.roma.it
authors.forename: L
authors.initials: L
authors.lastname: Fortunato
authors.forename: M
authors.initials: M
authors.lastname: Amini
authors.forename: L
authors.initials: L
authors.lastname: Costarelli
authors.forename: F R
authors.initials: FR
authors.lastname: Piro
authors.forename: M
authors.initials: M
authors.lastname: Farina
authors.forename: C E
authors.initials: CE
authors.lastname: Vitelli
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D006416:Hematoxylin; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008954:Models, Biological; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D006416:Hematoxylin