title: Achieving breast cancer surgery in a single setting with intraoperative frozen section analysis of the sentinel lymph node.
abstract: BACKGROUND
  Current guidelines recommend full axillary lymph node dissection (ALND) whenever the SLN is positive for metastases. In our institute, we aim to complete surgery in a single setting and base the decision for ALND on the intraoperative FS analysis of the SLN. In this study, we evaluate the efficacy this practice in terms of the accuracy of FS analysis, patient recall rate, and additional time required for FS analysis.
  
  
  METHODS
  Retrospective review was performed of 586 patients who underwent SLN biopsy at our institution from January 1, 2006 to December 31, 2010. Intraoperative FS analysis was routinely performed in all cases with a preoperative diagnosis of invasive breast cancer and in selected cases of ductal carcinoma in situ according to surgeon preference.
  
  
  RESULTS
  The SLN was positive for metastases in 123 (22.7%) patients; this was identified on FS analysis in 107 patients. FS analysis had a sensitivity of 87.0% and specificity of 100% and resulted in a patient recall rate of 3%. Micrometastasis accounted for most of the false negative FS results. These deposits were mostly detected only on deeper sectioning of the permanent sections of the SLN. An invasive lobular histology and lymphovascular invasion were found to be independent predictors of a false negative FS on multivariate analysis (P < .01). Intraoperative FS did not significantly prolong operating times.
  
  
  CONCLUSIONS
  Intraoperative FS analysis is an accurate and efficient means of rapid SLN assessment and allows ALND to be completed in a single setting.
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, Singapore. qinghui_sarah_lu@ttsh.com.sg
authors.forename: Qinghui
authors.initials: Q
authors.lastname: Lu
authors.forename: Ern-Yu
authors.initials: EY
authors.lastname: Tan
authors.forename: Bernard
authors.initials: B
authors.lastname: Ho
authors.forename: Christine
authors.initials: C
authors.lastname: Teo
authors.forename: Melanie D W
authors.initials: MD
authors.lastname: Seah
authors.forename: Juliana J C
authors.initials: JJ
authors.lastname: Chen
authors.forename: Patrick M Y
authors.initials: PM
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005629:Frozen Sections; D006801:Humans; D007432:Intraoperative Period; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010340:Pathology, Surgical; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D055815:Young Adult