title: Accuracy of intraoperative macroscopic diagnosis of sentinel node metastases in breast cancer: is accurate prediction possible?
abstract: BACKGROUND
  Accurate intraoperative diagnosis of sentinel lymph node (SLN) metastases enables the selection of patients who require axillary lymph node dissection, thus avoiding an additional operation. In this study we investigated the accuracy of intraoperative macroscopic diagnosis of SLN metastases in patients with breast cancer.
  
  
  METHODS
  SLNs from 276 breast cancer patients with clinically negative nodes were analyzed by macroscopic examination. The results of intraoperative macroscopic diagnosis were compared with those of frozen section analysis.
  
  
  RESULTS
  The sensitivity, specificity, overall accuracy, and false negative rate of SLN biopsy in the assessment of node status were 82.1%, 100%, 96.4%, and 17.9%, respectively, for frozen section analysis, and 57.1%, 95.5%, 87.7%, and 42.9%, respectively, for macroscopic evaluation. Even in patients with node metastasis >7 mm, the false negative rate of macroscopic evaluation was 11.1%.
  
  
  CONCLUSIONS
  Our results suggest that macroscopic diagnosis is less effective in predicting lymph node status in breast cancer than frozen section analysis. These findings imply that intraoperative macroscopic evaluation of sentinel nodes is never predictive of the final pathology.
authors.affiliation: Department of General Surgical Science, Graduate School of Medicine, Gunma Universiy, Gunma, Japan. ftakaaki@med.gunma-u.ac.jp
authors.forename: Takaaki
authors.initials: T
authors.lastname: Fujii
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yanagita
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Tomomi
authors.initials: T
authors.lastname: Fujisawa
authors.forename: Tomoko
authors.initials: T
authors.lastname: Hirakata
authors.forename: Sayaka
authors.initials: S
authors.lastname: Yamaki
authors.forename: Asuka
authors.initials: A
authors.lastname: Matsumoto
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Uchida
authors.forename: Misa
authors.initials: M
authors.lastname: Iijima
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007432:Intraoperative Period; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity