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Background: Sentinel lymph node biopsy (SLNB) has become the standard treatment for patients with invasive breast cancer. Intra-operative frozen section allows for the detection of nodal metastases, thereby allowing a simultaneous axillary lymph node dissection (ALND) for those patients with nodal metastases. We herein report the accuracy of frozen section in the detection of SLN metastases., Methods: Patients with operable breast cancer and clinically negative axillae were recruited for SLNB. The SLNs were identified by blue dye, an isotope, or a combination. Enlarged lymph nodes that were not SLNs were also excised. All nodes were examined by intra-operative frozen section. ALND was performed if frozen section was positive. For those without metastases on frozen section, ALND was not performed. All lymph nodes underwent further paraffin sectioning with immuno-histochemical staining., Results: A total of 260 SLNB procedures were performed for invasive carcinoma over a 3-year period. The SLN was identified in 93.5% of patients. Of the 243 successful procedures, 53 had nodal metastases on frozen section. A total of 33 patients had false-negative frozen sections (false-negative rate, 38.4%), and 97% of them were less than 2 mm in size. The false-negative rate for macro-metastases, micro-metastases, and isolated tumour cells&#95;were 2.4%, 57.7%, and 94.4%, respectively (p < 0.0001). A total of 22 patients had delayed ALND, and the re-operation rate was 8.5%., Conclusion: Frozen section was useful for the detection of nodal metastases in the SLNs and allowed for ALND to be performed in the same operation. The main failure of frozen sections was in the detection of micro-metastases., (Copyright © 2011 Asian Surgical Association. Published by Elsevier B.V. All rights reserved.)

Background: When ductal carcinoma in situ (DCIS) is found on core biopsy, histological underestimation can occur due to sampling error. When an invasive cancer is subsequently found, another operation is required for nodal staging. Sentinel lymph node biopsy (SLNB) enables nodal staging at the same operation. We examine the value of SLNB in patients with a preoperative diagnosis of DCIS focusing on the need for reoperation., Methods: Patients with a preoperative core biopsy of DCIS underwent SLNB at the time of definitive surgery. The results of SLNB in relation to histological upstaging were analyzed., Results: One hundred and seven patients with a core biopsy diagnosis of DCIS underwent simultaneous SLNB at the time of definitive surgery. SLNB was successful in 103 patients (96.3%) and 12 (11.7%) had SLN metastases. Thirty-two patients (29.9%) had histological upstaging and SLN was positive in nine (28.1%). Seventy-five patients had "pure DCIS" but three (4%) had SLN metastases. The presence of a palpable mass and radiological mass lesion were associated with histological upstaging. If SLNB were not performed, 32 patients (29.9%) with upstaging would require another surgery to stage the axilla. In the present series, 84% of these patients had appropriate axillary staging without the need for a second operation., Conclusion: Underestimation of invasive disease was frequent on core biopsy. Performing SLNB during definitive surgery allowed correct nodal staging in a single operation. SLN metastasis was rare in patients with "pure DCIS" on final pathology. However, additional systemic treatment may be indicated for patients with SLN micrometastases.

Background: Sentinel lymph node biopsy (SLNB) has been shown to be relatively accurate in axillary nodal staging in breast cancer. In more than half of the patients with metastatic sentinel lymph node (SLN), the SLN was the only lymph node involved in the axilla., Methods: A retrospective analysis was performed for those female Chinese breast cancer patients who underwent SLNB. All patients had axillary dissection after SLNB. Those patients with metastatic SLN were selected for analysis. Various tumour factors and SLN factors were analysed to study the association with residual lymph node metastasis., Results: A total of 139 SLNB was performed. The success rate of SLN localization, false negative rate and accuracy were 92%, 9% and 95%, respectively. Fifty-five patients had metastases in the SLN. In 38 patients (69%), SLN was the only lymph node involved in the axilla. Tumours <3 cm, a single metastatic SLN, presence of micro metastases and the absence of extracapsular spread in the SLN were associated with the absence of metastasis in the non-sentinel lymph nodes., Conclusion: Sentinel lymph node biopsy is accurate in the nodal staging of Chinese breast cancer patients. Several factors such as tumour <3 cm, a single metastatic SLN, micro metastases and the absence of extracapsular spread in the sentinel node(s) are useful predictors for the absence of residual disease in the axilla. With further studies and verification, these factors may prove to be important in determining which patients with metastatic SLN will require further axillary treatment. Until such information is available, axillary dissection should be performed when positive sentinel nodes are found.