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Effectiveness of multiple-level sectioning in detecting axillary nodal micrometastasis in breast cancer: a
P J Zhang1, R M Reisner, R Nangia
1Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY 14263-0001, USA.
Objective:
To evaluate the effectiveness of original multiple-level sectioning in detecting axillary nodal micrometastasis in breast carcinoma.
Design:
Retrospective analysis of 707 axillary nodes from 34 consecutive node-negative invasive breast cancers from the years 1989 and 1990. All but 2 cases were originally examined by multiple-level sectioning. The original histologic sections were reviewed. Additional sections were cut for hematoxylin-eosin staining and cytokeratin immunohistochemistry.
Results:
A micrometastasis was found in only 1 case (1 node) on the original histologic section, which was 1 of the 2 cases not originally processed by multiple-level sectioning. Additional sections and cytokeratin immunostains were negative on all cases, including the false-negative case identified on original section.
Conclusions:
The finding of a micrometastasis in 1 case on the original, but not on any additional recuts or cytokeratin immunostains, indicates that the original multiple-level sectioning was very effective (0% false negatives). Immunohistochemistry provided no additional benefit in detecting micrometastases in cases already examined by multiple-level sectioning. Thorough histologic examination on properly prepared sections is probably the most efficient and cost-effective way to detect the vast majority of axillary nodal micrometastases.
Insights
Multiple-level sectioning effectively detects breast cancer micrometastasis in axillary lymph nodes. This thorough histologic method proved highly accurate, with immunohistochemistry offering no additional benefit for micrometastasis detection.
Area of Science:
- Oncology
- Pathology
- Surgical Pathology
Background:
- Accurate detection of axillary nodal micrometastasis is crucial for breast cancer staging and treatment.
- Traditional methods may have limitations in identifying small metastatic deposits.
Purpose of the Study:
- To assess the efficacy of multiple-level sectioning in identifying axillary nodal micrometastasis in invasive breast carcinoma.
- To compare the diagnostic yield of multiple-level sectioning with additional sectioning and immunohistochemistry.
Main Methods:
- Retrospective analysis of 707 axillary lymph nodes from 34 node-negative invasive breast cancer cases.
- Review of original histologic sections, with additional sections prepared for H&E staining and cytokeratin immunohistochemistry.
Main Results:
- Micrometastasis was identified in only one case (1 node) on the original section.
- This single positive case was among the two not originally processed with multiple-level sectioning.
- Additional sections and cytokeratin immunohistochemistry did not detect any additional micrometastases.
Conclusions:
- Original multiple-level sectioning demonstrated high effectiveness in detecting axillary nodal micrometastasis, with 0% false negatives in cases properly examined.
- Immunohistochemistry did not provide added value for micrometastasis detection when multiple-level sectioning was employed.
- Thorough histologic examination using multiple-level sectioning is an efficient and cost-effective approach for detecting most axillary nodal micrometastases.