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Related Experiment Videos

Interpretive disparity among pathologists in breast sentinel lymph node evaluation.

Cory A Roberts1, Peter D Beitsch, Craig E Litz

  • 1Department of Pathology, St Paul University Hospital and University of Texas Southwestern Medical Center, Dallas, TX, USA. croberts@propathlab.com

American Journal of Surgery
|October 14, 2003
PubMed
Summary

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Pathologists struggle to accurately identify breast cancer micrometastases in sentinel lymph nodes (SLN) using immunohistochemistry (IHC). Accuracy decreases with fewer tumor cells, suggesting a need for an "indeterminate" classification.

Area of Science:

  • Oncology
  • Pathology
  • Surgical Pathology

Background:

  • The diagnostic accuracy of immunohistochemical staining on breast sentinel lymph nodes (SLN) remains a subject of debate.
  • Accurate staging of breast cancer relies heavily on the precise evaluation of lymph node involvement.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of pathologists in identifying breast cancer micrometastases in SLN using both hematoxylin and eosin (H&E) and immunohistochemistry (IHC).
  • To assess the impact of tumor cell number on diagnostic accuracy.

Main Methods:

  • Ten pathologists reviewed 25 SLN cases with varying tumor burdens (negative, micrometastases, macrometastasis).
  • Cases were stained with H&E and IHC, and pathologists provided "positive," "negative," or "indeterminate" assessments.

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Main Results:

  • The mean number of incorrect responses was higher for IHC (6.6) than H&E (5).
  • 80% of positive IHC cases were incorrectly scored by at least one pathologist.
  • Diagnostic accuracy significantly decreased as the number of tumor cells diminished, with over 30% of pathologists erring when fewer than 10 tumor cells were present.

Conclusions:

  • Pathologists' ability to detect micrometastases in SLN decreases with fewer tumor cells.
  • An "indeterminate" category is proposed for cases with fewer than 10 tumor cells to improve diagnostic consistency.