Advantages of partial intraoperative pathologic evaluation of sentinel lymph node biopsy – our experience in 267 cases of breast cancer and review of the methods

Lymph node disease involvement remains one of the most important prognostic indicator of overall survival and axillary dissection has long been the standard procedure for determining the nodal stage in Breast Cancer (BC), before the technique of Sentinel Lymph Node (SLN) was widely accepted. Until recently, SLN evaluation performed by total Intraoperative Definitive Evaluation by H&E and IHC with more than 50 section, as described by Viale and Coll. is expensive and needs time but is definitive, on the other hand microscopic examination of delayed paraffin section necessitated a second surgical approach for complete Axillary Lymph Node Dissection (ALND)if the SLN appeared to be positive for metastases, that is in more than 30% of cases. To avoid this reoperation and the patient stress correlated by reduncing costs and time of full examination, a Partial Intraoperative Pathologic SLN Evaluation (IPPE) has been proposed, four section only by H&E. If the IPPE of the SLN is positive the ALND is immediately performed sparing the unpleasant return of the patient to the operating room. The partial intraoperative SLN biopsy is always followed, with a delay of few days by the definitive evaluation of the lymph node status. Patients with positive SLN at the definitive evaluation will require a second operative procedure within 15 days.