[Value of intraoperative frozen section of sentinel lymph node in breast cancer. Retrospective study about 293 patients].
OBJECTIVE
Intraoperative positive frozen section of sentinel axillary lymph node in breast cancer allows the full node dissection at the same time of the breast surgery and the enhancement of adjuvant therapies with no delay. The low frequency of node involvement and the high rate of false-negative, make consider the value of intraoperative frozen section. The aim of this study was to analyze the potential advantage of intraoperative frozen section performed routinely.


METHODS
Retrospective monocentric study of 293 patients, operated on for stage pT1 or pT2 breast cancer with a sentinel node biopsy (SNB).


RESULTS
A total of 289 patients had an intraoperative frozen section of the SNB. A sentinel node was identified in 98.6% of the cases. On intraoperative section, sentinel node was negative, positive or was not performed in 252 (86%), 37 (12.6%) and 4 (1.4%) cases respectively. In total, ibtraoperative frozen sections identified 48.7% of the metastatic SNB (37/76). The metastatic lymph node distribution, after final histological analysis, was as follows: 17% macro metastasis, 5.8% micro metastasis and 3% isolated tumor cells. The false-negatives rate was 13.5%. Fifty-eight patients (19.8%) underwent axillary full lymph node dissection: 39 during a primary surgery and 19 during a secondary one. Histological analysis of the lymph nodes was totally negative in 62% of cases. Intraoperative frozen sections benefited to 12.8% of the patients who had their full lymph node dissection at the same surgery.


CONCLUSIONS
The intraoperative frozen section of SNB benefits to a limited number of patients, due to its high rate of false-negatives. Sensitivity of frozen sections could be lowered if the preoperative axillary ultrasound examination becomes a routine, which would question its value.
Service de chirurgie gynécologique et oncologique, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. Electronic address: nathalie.hoen@chu-lyon.fr.
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Hoen
Service de chirurgie gynécologique et oncologique, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
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Pral
Service de chirurgie gynécologique et oncologique, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
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Golfier
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005188:False Negative Reactions; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007430:Intraoperative Care; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008408:Mastectomy; D008875:Middle Aged; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy
Axillary node dissection; Breast cancer; Cancer du sein; Curage axillaire; Examen extemporané; Frozen section; Ganglion sentinelle; Sentinel lymph node