Abstract
Background
Intraoperative frozen section (IFS) examination of sentinel lymph nodes (SLN) is useful
in selecting patients with invasive breast cancer for immediate axillary lymph node
dissection. However, whether IFS evaluation of the SLNs in ductal carcinoma in situ
(DCIS) of the breast has any value has not been previously assessed.
Methods
Clinicopathologic data from patients with DCIS who underwent resection with SLN biopsy
(2004-2010) were collected to assess the sensitivity, specificity, and accuracy of
IFS, and its impact on axillary management.
Results
A total of 267 patients with DCIS underwent resection with SLN biopsy and IFS evaluation.
Preoperative pathology was DCIS (n = 231), DCIS with microinvasion (n = 24), and DCIS
with other lesions (n = 12). Fifty-two (19.5%) patients had invasive breast cancer
on final pathology. SLN metastases were identified in 13 (4.8%) patients; however,
only 4 (1.5%) were IFS positive. IFS examination was negative in 263 (98.5%) patients.
Among patients with SLN metastases, the most common pattern of metastases was either
micrometastasis (n = 6) or immunohistochemistry-positive individual tumor cells (n =
4), whereas 3 patients had a macrometastasis. IFS examination was falsely negative
in 9 of these 13 patients for a false-negative rate of 69.3%, and a sensitivity and
specificity of 31% and 100% respectively. Nine of the 13 patients underwent axillary
lymph node dissection and only 1 patient had further axillary metastasis.
Conclusions
SLN metastases in DCIS is rare and most commonly involves SLN micrometastasis or immunohistochemistry-positive
individual tumor cells. SLN IFS evaluation in DCIS has a low yield and sensitivity,
and can be safely omitted to reduce operative duration and cost.
Keywords
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Article info
Publication history
Published online: June 21, 2013
Accepted:
February 4,
2013
Received in revised form:
January 31,
2013
Received:
October 15,
2012
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
