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Omission of Routine Frozen Section for Clinically Node-Negative Patients Undergoing Upfront Mastectomy Avoids
Rachel E Sargent1, Andrea V Barrio1, Srinivasa V Sevilimedu2
1Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Annals of Surgical Oncology
|July 16, 2025
Summary
Omitting routine frozen section during upfront mastectomy for early-stage breast cancer patients significantly reduced the need for completion axillary lymph node dissection (ALND). This change optimized axillary treatment, with only 6% requiring further surgery.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Management
Background:
- Postmastectomy radiation/regional nodal irradiation (PMRT) is safe for cN0 patients with 1-2 positive sentinel lymph nodes (+SLNs) after mastectomy.
- A policy change in January 2022 omitted routine frozen section analysis for cT1-3N0 patients undergoing upfront mastectomy.
Purpose of the Study:
- To evaluate the impact of omitting routine frozen section on axillary treatment decisions.
- To assess rates of axillary lymph node dissection (ALND) and PMRT following the policy change.
Main Methods:
- Retrospective review of consecutive cT1-3N0 breast cancer patients undergoing upfront mastectomy (January 2022 - July 2023).
- ALND was indicated for patients with ≥3 +SLNs or 1-2 +SLNs not meeting PMRT criteria.
- Evaluation of ALND and PMRT rates post-policy implementation.
Main Results:
- Of 623 patients, 4.7% underwent completion ALND (cALND), often associated with larger tumors, lobular histology, and lymphovascular invasion (LVI).
- Among 98 patients with 1-2 +SLNs, 88% received PMRT without further surgery; 8% had ALND for non-PMRT criteria.
- For patients with ≥3 +SLNs (n=29), 72% had both ALND and PMRT; 28% had PMRT alone or neither.
Conclusions:
- Routine omission of frozen section at upfront mastectomy resulted in only 6% of cN0 patients needing completion ALND.
- The incidence of ALND plus PMRT for patients with 1-2 positive nodes was low (2%).
- This strategy effectively optimized axillary management for cT1-3N0 breast cancer patients.
