title: Analysis of sentinel node biopsy - a single-institution experience supporting the use of serial sectioning and immunohistochemistry for detection of micrometastases by comparing four different histopathological laboratory protocols.
abstract: OBJECTIVE
  Detecting micrometastases (>0.2 and ≤2 mm/>200 cells) and isolated tumour cells (ITCs; ≤0.2 mm/<200 cells) is important for staging of breast cancer patients. The aim of this study was to systematically compare several laboratory protocols used to detect metastases after initial intraoperative frozen section examination.
  
  
  RESULTS
  Four different protocols for the work-up of sentinel lymph nodes (SLNs) after frozen sectioning were applied in the routine diagnostic process from 2001 to 2009. In addition, team-work with a limited number of laboratory technicians and pathologists handling SLNs was introduced in 2008. The present study shows that there were, overall, significantly more node-positive patients in the period when team-work and intensive step sections including immunohistochemistry (IHC) were used (P = 0.01). This resulted in 13% more patients being found to have ITCs and micrometastases than in a time period when only step sections were performed. No increase in the number of false-negative frozen sections was seen.
  
  
  CONCLUSIONS
  Future guidelines for pathological work-up of sentinel nodes in women with breast cancer might include team-work and IHC if frozen sections are used intraoperatively.
authors.affiliation: Department of Pathology, University Hospital of Lund, Lund, Sweden. Dorthe.grabau@skane.se
authors.forename: Dorthe
authors.initials: D
authors.lastname: Grabau
authors.forename: Lisa
authors.initials: L
authors.lastname: Ryden
authors.forename: Mårten
authors.initials: M
authors.lastname: Fernö
authors.forename: Christian
authors.initials: C
authors.lastname: Ingvar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005629:Frozen Sections; D006652:Histological Techniques; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008875:Middle Aged; D061206:Neoplasm Micrometastasis / Q000175:diagnosis*; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy; D055815:Young Adult