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Intraoperative sentinel lymph node examination by frozen section, immunohistochemistry and imprint cytology during
F Celebioglu1, M Sylvan, L Perbeck
1Department for Clinical Science, Intervention and Technology, Karolinska University Hospital Solna, Division of Surgery/Bröstcentrum, 17176 Stockholm, Sweden. Fuat.celebioglu@karolinska.se
Insights
Intraoperative frozen section with hematoxylin-eosin (H&E) and immunohistochemistry (IHC) improves sentinel lymph node analysis in breast cancer, especially for macrometastases detection.
Area of Science:
- Oncology
- Surgical Pathology
Background:
- Accurate intraoperative analysis of sentinel lymph nodes (SN) is crucial for breast cancer staging and treatment decisions.
- Frozen section analysis is a common method for rapid pathological assessment during surgery.
Purpose of the Study:
- To compare the diagnostic sensitivity of intraoperative frozen section using hematoxylin-eosin (H&E) staining, immunohistochemistry (IHC), and imprint cytology (IC) for sentinel node (SN) analysis in breast cancer.
- To evaluate the effectiveness of combining H&E and IHC for improved SN metastasis detection.
Main Methods:
- A prospective study involving 102 breast cancer patients undergoing SN biopsy.
- Analysis of SN using intraoperative frozen sections with H&E staining, IHC, and IC.
- Comparison of sensitivities for detecting both macrometastases and micrometastases.
Main Results:
- Individual sensitivities for H&E, IHC, and IC were 73.5%, 75.5%, and 51.0%, respectively.
- Combining H&E and IHC increased overall sensitivity to 83.7%.
- H&E demonstrated 100% sensitivity for macrometastases, while combined H&E and IHC sensitivity for micrometastases reached 55.0%.
Conclusions:
- Intraoperative frozen section with H&E staining is highly sensitive for detecting macrometastases but less so for micrometastases in breast cancer SN.
- Intraoperative IHC offers a marginal improvement for micrometastasis detection when combined with H&E.
- Imprint cytology provides no significant additional diagnostic value for SN analysis in this setting.
Abstract:
The aim of this study was to compare the sensitivity of intraoperative frozen section with hematoxyllin-eosin (H&E) staining, immunohistochemistry (IHC) or imprint cytology (IC) in the analysis of sentinel node (SN) in breast cancer. Towards this end, a prospective study of 102 patients undergoing mastectomy or sector resection with SN biopsy was conducted. Frozen sections of SN with H&E, IHC staining and IC had sensitivities of 73.5%, 75.5% and 51.0%, respectively. The combination of H&E and IHC raised the overall sensitivity to 83.7%. Macrometastases (>2 mm) were detected in 100% of the cases with H&E, 92.6% with IHC and 81.5% with IC; and micrometastases (2 mm) in 35.0%, 45.0% and 5.0%, respectively. The combination of H&E and IHC staining raised the sensitivity to 55.0%. Frozen-section analysis with H&E staining showed high sensitivity in detecting macrometastases but not micrometastases. The sensitivity for detection of micrometastases was not substantially increased by the use of intraoperative IHC. Imprint cytology did not provide any additional information.
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