Background. Frozen Section (FS) intraoperatively performed on Sentinel Lymph Node (SLN) has low sensitivity for detecting micro-metastases (< 2 mm), resulting in patients who later undergo deferred axillary dissection. The results of recent trials as ACOSOG Z0011 and IBCSG 23-10 changed our approach to the management of the axilla in case of positive SLN. Aim of the study is to determine the best clinical approach to deciding which patients would derive real benefit from ALND, minimizing the functional and psychological damage caused by a delayed surgery while also minimizing the risk of undertreating EBC patients. Methods. We evaluated 1453 patients with early breast cancer (EBC) undergone SLN biopsy, FS and definitive evaluation, focusing on cause of discrepancy and the need for further surgery. Results. FS were carried out in 1226 cases (86%). False negative FS were 146 (11.9%). The global sensitivity of FS in detecting both macro and micrometastases was 53.7% . According to ACOSOG Z0011 criteria ALND could be spared in 236 patients, but 40 were found having > 3 positive axillary lymph nodes (17%). Applying the IBCSG23-10 trial criteria, (3.1%) we found patients with>3 positive axillary lymph nodes in 3 cases only. Conclusions. This study confirms the low sensitivity of FS in detecting micrometastases (19%) and a reasonable sensitivity for macrometastases (75%). False negatives were more commonly smaller metastases (mean 2.1mm) and more likely in Infiltrating Lobular Carcinoma. If we retrospectively modelled the IBCSG 23-10 criteria, we would have found a reduction of deferred surgery from 12% to 4%. In case of patients with 4 axillary metastatic lymph nodes, the main guidelines recommend irradiation of lymph node drainage stations. Patients who met Z0011 criteria showed that, if we did not perform an ALND they would have been undertreated. This risk decreases to 3% omitting the axillary clearing only in case of micrometastases.
Frozen section in sentinel lymph node biopsy for breast cancer in the era of ACOSOG Z0011 and IBCSG 23-10 trials / Lombardi, A.; Maggi, S.; Stanzani, G.; Vitale, V.; Amanti, Claudio. - In: EUROPEAN JOURNAL OF CANCER. - ISSN 0959-8049. - ELETTRONICO. - 9253:(2018), pp. 63-63. (Intervento presentato al convegno European Breast Cancer Conference 11th tenutosi a Barcellona, Spagna nel 21-23 marzo 2018).
Frozen section in sentinel lymph node biopsy for breast cancer in the era of ACOSOG Z0011 and IBCSG 23-10 trials
A. Lombardi
Writing – Review & Editing
;S. Maggi
Membro del Collaboration Group
;AMANTI, Claudio
Supervision
2018
Abstract
Background. Frozen Section (FS) intraoperatively performed on Sentinel Lymph Node (SLN) has low sensitivity for detecting micro-metastases (< 2 mm), resulting in patients who later undergo deferred axillary dissection. The results of recent trials as ACOSOG Z0011 and IBCSG 23-10 changed our approach to the management of the axilla in case of positive SLN. Aim of the study is to determine the best clinical approach to deciding which patients would derive real benefit from ALND, minimizing the functional and psychological damage caused by a delayed surgery while also minimizing the risk of undertreating EBC patients. Methods. We evaluated 1453 patients with early breast cancer (EBC) undergone SLN biopsy, FS and definitive evaluation, focusing on cause of discrepancy and the need for further surgery. Results. FS were carried out in 1226 cases (86%). False negative FS were 146 (11.9%). The global sensitivity of FS in detecting both macro and micrometastases was 53.7% . According to ACOSOG Z0011 criteria ALND could be spared in 236 patients, but 40 were found having > 3 positive axillary lymph nodes (17%). Applying the IBCSG23-10 trial criteria, (3.1%) we found patients with>3 positive axillary lymph nodes in 3 cases only. Conclusions. This study confirms the low sensitivity of FS in detecting micrometastases (19%) and a reasonable sensitivity for macrometastases (75%). False negatives were more commonly smaller metastases (mean 2.1mm) and more likely in Infiltrating Lobular Carcinoma. If we retrospectively modelled the IBCSG 23-10 criteria, we would have found a reduction of deferred surgery from 12% to 4%. In case of patients with 4 axillary metastatic lymph nodes, the main guidelines recommend irradiation of lymph node drainage stations. Patients who met Z0011 criteria showed that, if we did not perform an ALND they would have been undertreated. This risk decreases to 3% omitting the axillary clearing only in case of micrometastases.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
