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Is Routine Intraoperative Frozen-Section Examination of Sentinel Lymph Nodes in Breast Cancer Worthwhile? (2000)

Weiser, Martin R. ; Montgomery, Leslie L. ; Susnik, Barbara ; [et al.]

Springer

Annals of surgical oncology 7 (2000), S. 651-655

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ISSN: 1534-4681

Keywords: Sentinel lymph nodes ; Frozen section ; Macrometastases ; Micrometastases

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract Background: Routine intraoperative frozen section (FS) of sentinel lymph nodes (SLN) can detect metastatic disease, allowing immediate axillary dissection and avoiding the need for reoperation. Routine FS is also costly, increases operative time, and is subject to false-negative results. We examined the benefit of routine intraoperative FS among the first 1000 patients at Memorial Sloan Kettering Cancer Center who had SLN biopsy for breast cancer. Methods: We performed SLN biopsy with intraoperative FS in 890 consecutive breast cancer patients, none of whom had a back-up axillary dissection planned in advance. Serial sections and immunohistochemical staining for cytokeratins were performed on all SLN that proved negative on FS. The sensitivity of FS was determined as a function of (1) tumor size and (2) volume of metastatic disease in the SLN, and the benefit of FS was defined as the avoidance of a reoperative axillary dissection. Results: The sensitivity of FS ranged from 40% for patients with T1a to 76% for patients with T2 cancers. The volume of SLN metastasis was highly correlated with tumor size, and FS was far more effective in detecting macrometastatic disease (sensitivity 92%) than micrometastases (sensitivity 17%). The benefit of FS in avoiding reoperative axillary dissection ranged from 4% for T1a (6 of 143) to 38% for T2 (45 of 119) cancers. Conclusions: In breast cancer patients having SLN biopsy, the failure of routine intraoperative FS is largely the failure to detect micrometastatic disease. The benefit of routine intraoperative FS increases with tumor size. Routine FS may not be indicated in patients with the smallest invasive cancers.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/s10434-000-0651-3

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Quantitative evaluation of malignant potential of early breast cancer using high resolution image cytometry (1993)

Palcic, Branko ; Susnik, Barbara ; Garner, David ; [et al.]

New York, N.Y. : Wiley-Blackwell

Journal of Cellular Biochemistry 53 (1993), S. 107-113

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ISSN: 0730-2312

Keywords: Early breast cancer ; image cytometry ; malignant potential ; nuclear features ; Life and Medical Sciences ; Cell & Developmental Biology

Source: Wiley InterScience Backfile Collection 1832-2000

Topics: Biology , Chemistry and Pharmacology , Medicine

Notes: We have been testing two independent hypotheses which postulate that the malignant potential of early breast cancer can be objectively assessed by measuring nuclear features of the diagnostic-malignant cells (hypothesis I) and/or normal-appearing epithelial cells found in the vicinity of the carcinoma (hypothesis II). In preliminary experiments, we tested some of these hypotheses using historical samples and a high resolution image cytometry apparatus. Tissue sections were stained with our stoichiometric stain and over 60 nuclear features, primarily texture features describing the DNA distribution in the nuclei, were employed in the multivariate analyses. Data derived from measurements of ductal carcinoma in situ (DCIS) with and without the invasive component indicated that the malignant potential of these lesions can be estimated with a sensitivity and specificity of at least 80%. The analysis of the tissue surrounding an invasive breast carcinoma showed that the existing malignancy can be predicted solely from the measurements of normal nuclei (normal-appearing breast lobules) in more than 85% of patients. This result indicates that the analysis of benign tissues also could give prognostically valid information.These results can be greatly improved using larger sample sizes and other improvements, including technical improvements of the cytometry device. We believe that this approach can be developed into a practical diagnostic and prognostic tool for better management of early breast cancer.

Additional Material: 5 Ill.