EFFECTIVENESS OF MULTIPLE-LEVEL SECTIONING IN DETECTING AXILLARY NODAL MICROMETASTASIS IN BREAST-CANCER - A RETROSPECTIVE STUDY WITH IMMUNOHISTOCHEMICAL ANALYSIS

Objective.-To evaluate the effectiveness of original multiple-level se ctioning in detecting axillary nodal micrometastasis in breast carcino ma. Design.-Retrospective analysis of 707 axillary nodes from 34 conse cutive node-negative invasive breast cancers from the years 1989 and 1 990. All but 2 cases were originally examined by multiple-level sectio ning. The original histologic sections were reviewed. Additional secti ons were cut for hematoxylin-eosin staining and cytokeratin immunohist ochemistry. Results.-A micrometastasis was found in only 1 case (1 nod e) on the original histologic section, which was 1 of the 2 cases not originally processed by multiple-level sectioning. Additional sections and cytokeratin immunostains were negative on all cases, including th e false-negative case identified on original section. Conclusions.-The finding of a micrometastasis in 1 case on the original, but not on an y additional recuts or cytokeratin immunostains, indicates that the or iginal multiple-level sectioning was very effective (0% false negative s). Immunohistochemistry provided no additional benefit in detecting m icrometastases in cases already examined by multiple-level sectioning. Thorough histologic examination on properly prepared sections is prob ably the most efficient and cost-effective way to detect the vast majo rity of axillary nodal micrometastases.