title: The importance of pre-operative axillary ultra-sound and intra-operative sentinel lymph node frozen section analysis in patients with early breast cancer--a 3-year study.
abstract: BACKGROUND
  To ensure appropriate axillary surgery is performed at a single operation, we have sought to identify patients with involved nodes who might progress directly to axillary dissection.
  
  
  METHODS
  We evaluated pre-operative ultrasound of the axilla and intra-operative  frozen section of sentinel lymph nodes over a 3-year period. Patients with clinical early breast cancer underwent axillary ultrasound. Abnormal nodes were defined as a cortex > 2.5 mm, loss of high echogenic medulla, and morphological changes. Any axilla containing a lymph node considered  abnormal had ultrasound-directed fine needle aspiration (FNA) performed. Patients with positive cytology proceeded directly to axillary dissection. Patients with negative cytology and those with normal ultrasound proceeded to sentinel four-node biopsy using Patent Blue dye alone. A single  sentinel node was evaluated by intra-operative frozen section.
  
  
  RESULTS
  A total of 311 patients underwent pre-operative ultrasound successfully, identifying 115 (77%) patients of the total 150 who were found to have positive lymph nodes. Overall, 196 patients underwent sentinel lymph node  biopsy analysis intra-operatively. Of the 11 false negative cases in which the lymph node was found to be positive postoperatively, eight cases showed the single tested sentinel node contained cancer that was recognised on postoperative staining but not frozen section. In six, the deposit  in the sentinel node was a micrometastasis. Three cases were found to contain cancer in the 'non-sentinel' node; in all, this was micrometastatic disease.
  
  
  CONCLUSIONS
  This study confirms the value of pre-operative ultrasound and intra-operative frozen section examination of axillary nodes.  Only 3.5% of patients required two operations.
authors.affiliation: Breast Unit, Mayday University Hospital, Croydon, Surrey, UK.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Sanders
authors.forename: Shamaela
authors.initials: S
authors.lastname: Waheed
authors.forename: Sanjay
authors.initials: S
authors.lastname: Joshi
authors.forename: Caroline
authors.initials: C
authors.lastname: Pogson
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Ebbs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012017:Referral and Consultation; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D014463:Ultrasonography