title: Intra-operative evaluation of the sentinel lymph node for T1-N0 breast-cancer patients: always or never? A risk/benefit and cost/benefit analysis.
abstract: OBJECTIVE
  To investigate whether omitting intra-operative staging of the sentinel lymph node (SLN) in T1-N0 breast-cancer patients is feasible and convenient because it could allow a more efficient management of human and logistic resources without leading to an unacceptable increase in the rate of delayed axillary lymph node dissection (ALND).
  
  
  METHODS
  According to the experimental procedure, T1a-T1b-patients were to not receive any intra-operative SLN evaluation on frozen sections (FS). In all T1c-patients, the SLN was macroscopically examined; if the node appeared clearly free of disease, no further intra-operative assessment was performed; if the node was clearly metastatic or presented a dubious aspect, the pathologist proceeded with analysis on FS. T2-patients, enrolled in the study as reference group, were treated according to the institutional standard procedure; they all received SLN staging on FS.
  
  
  RESULTS
  The study included 395 T1-N0-patients. Among the 118 T1a-T1b-patients whose SLN was not analyzed at surgery, 12 (10.2%) were recalled for ALND. In the group of 258 T1c-patients, 112 received SLN analysis on FS and 146 did not. An SLN falsely negative either at macroscopic or FS examination was found in 33 (12.8%) cases. Overall, the rate of recall for ALND was 11.6% as compared to 8.4% in T2-patients. Using the experimental protocol, the institution reached a 9.6% cost saving, as compared to the standard procedure.
  
  
  CONCLUSIONS
  Omission of SLN intra-operative staging in T1-N0-patients is rather safe. It provides the institution with both management and economical advantages.
authors.affiliation: Advanced Surgical Senology Unit, National Cancer Research Institute, Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Canavese
authors.forename: P
authors.initials: P
authors.lastname: Bruzzi
authors.forename: A
authors.initials: A
authors.lastname: Catturich
authors.forename: C
authors.initials: C
authors.lastname: Vecchio
authors.forename: D
authors.initials: D
authors.lastname: Tomei
authors.forename: F
authors.initials: F
authors.lastname: Carli
authors.forename: M
authors.initials: M
authors.lastname: Truini
authors.forename: G B
authors.initials: GB
authors.lastname: Andreoli
authors.forename: V
authors.initials: V
authors.lastname: Priano
authors.forename: B
authors.initials: B
authors.lastname: Dozin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics / Q000473:pathology* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D005629:Frozen Sections; D017048:Health Care Costs; D006801:Humans; D007432:Intraoperative Period; D007558:Italy; D008197:Lymph Node Excision / Q000191:economics*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D016896:Treatment Outcome