The optimal management of the axillae of patients with microinvasive breast cancer in the sentinel lymph node era.

Background: For patients with microinvasive breast cancer, the value of intraoperative analysis of sentinel lymph nodes (SLNs) and complete axillary lymph node dissection (CALND) is not well known.
Methods: All patients staged T1mic from 2001 to 2005 were analyzed.
Results: Among all 81 patients, 4 (5%) had SLN metastases detected with hematoxylin and eosin staining and 2 (2%) had metastases identified by immunohistochemistry staining only. Seventy-seven patients (95%) underwent SLN biopsy; 3 (4%) had hematoxylin and eosin SLN metastases and 2 (3%) had immunohistochemistry-detected metastases. One SLN metastasis was identified on frozen section analysis. No patient with a SLN metastasis had additional metastases on CALND. The patient charges for frozen section analyses were $39,578 for 77 patients. This prevented 1 reoperative CALND at a charge of $20,274.
Conclusions: Frozen section analysis should be used only in select patients with microinvasive breast cancer and CALND is of limited value for these patients.