Lymph node metastasis in patients with frozen section analyses that are negative for tumors.
OBJECTIVE
This study was designed to assess the necessity of delayed complete axillary lymph node dissection (cALND) for patients whose sentinel lymph nodes (SLNs) were negative for tumors on intraoperative frozen section analysis, but later proven positive on hematoxylin and eosin staining or immunohistochemistry.


METHODS
We identified 341 patients who underwent sentinel lymph node biopsy (SLNB) with cALND at the Samsung Medical Center between 1998 and 2008, and reviewed the clinicopathological records of women diagnosed with invasive carcinoma of the breast.


RESULTS
Of the 341 patients, 59 underwent delayed cALND due to negative results on frozen section. Only 1 patient had a non-SLNs metastasis in the group of delayed cALND. Delayed cALND was associated with higher rates of breast-conserving surgery, smaller primary tumor and metastasis size in SLNs, fewer metastatic lymph nodes and SLNs and a lower TNM stage. The detection of metastases of SLNs on frozen section and the number of metastatic SLNs were related to the detection of additional metastases of nonsentinel lymph nodes (NSLNs) in cALND.


CONCLUSIONS
Our findings suggest that the lack of detection of metastases on frozen sections may be a predictive factor for nonmetastasis in NSLNs. cALND could therefore be omitted in such cases.
Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea.
Se Kyung
SK
Lee
Kyo Won
KW
Lee
Sangmin
S
Kim
Min-Young
MY
Choi
Jiyoung
J
Kim
Jeonghui
J
Lee
Seung Pil
SP
Jung
Jun-Ho
JH
Choe
Jung-Han
JH
Kim
Jee Soo
JS
Kim
Jeong Eon
JE
Lee
Jung-Hyun
JH
Yang
Seok Jin
SJ
Nam
D000328:Adult; D001365:Axilla / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D004801:Eosine Yellowish-(YS); D005260:Female; D005629:Frozen Sections; D006416:Hematoxylin; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology*; D015412:Mastectomy, Segmental; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D015996:Survival Rate; D013997:Time Factors
D004801:Eosine Yellowish-(YS); D006416:Hematoxylin