Can Intraoperative Analysis of Sentinel Lymph Nodes be Abandoned in Early-stage Breast Cancer?

After the ACOSOG Z0011 study, the rate of axillary dissection(AD) decreased in patients undergoing breast-conserving surgery(BCS). With the expansion of AD criteria in patients undergoing mastectomy in the NCCN 2025 guideline, intraoperative frozen section(iFS) analysis in early-stage breast cancer has become controversial. This study aims to evaluate the feasibility of iFS analysis in patients with early-stage breast cancer and the adequacy of only permanent section analysis. iFS analysis was performed on 187 patients with node-negative early-stage breast cancer between March 2022 and December 2024. Clinically and radiologically node-negative T1-2 tumors with sentinel lymph node biopsy were included. Clinicopathological data of patients who underwent mastectomy and BCS were analyzed. Sentinel lymph node involvement rates and reoperation rates prevented by iFS analysis were reported. Of 187 patients with early-stage breast cancer, 64 underwent mastectomy and 123 underwent BCS with sentinel lymph node biopsy. Sentinel lymph node metastases were detected in 18.7% of the patients. More than two nodal metastases were detected in two of 187 patients (1.1%). More than two nodal metastases were not detected in patients who underwent mastectomy. Intraoperative frozen section analysis prevented reoperation for AD in 1.1% of all patients. The false-negative rate of iFS was 2.1%. No significant difference was detected between the AD rates between the two groups (p = 0.547). In early-stage breast cancer patients with clinically negative axillary nodes, the benefit of iFS appears limited, selective rather than routine use of iFS may be appropriate and permanent section evaluation alone may be sufficient in most cases. Our findings may help avoid iFS analysis.