Intraoperative pathologic evaluation of a breast cancer sentinel lymph node biopsy as a determinant for synchronous axillary lymph node dissection

Background: Intraoperative pathologic evaluation of a breast cancer sentine l lymph node (SLN) biopsy permits synchronous axillary lymph node dissectio n (ALND), but frozen section is time consuming and potentially inaccurate. This study evaluated intraoperative gross examination and touch prep analys is (TPA) of a breast cancer SLN biopsy as determinants for synchronous ALND . Methods: Intraoperative gross examination/TPA were performed on the SLN of consecutive breast cancer patients from 1997 to 2000. Patients with an intr aoperative "positive" SLN underwent synchronous ALND. Intraoperative result s were compared with the final pathology. Results: Thirty-seven of 150 patients had a positive SLN on final pathology . Intraoperative gross examination/TPA identified 54% (20 of 37) of these p atients. All intraoperative "positive" patients underwent synchronous ALND. Of 17 "false-negative" findings, 53% (9 of 17) had micrometastatic disease , There were no "false-positive" results. Overall sensitivity and specifici ty were 54% and 100%, respectively. Conclusions: Gross examination/TPA are simple, rapid techniques for the int raoperative evaluation of a breast cancer SLN. As there were no false-posit ive results, the rationale behind SLN biopsy was preserved. These technique s permitted synchronous ALND in over half of all patients with a positive S LN. This represents a potential benefit to the patient by eliminating a sec ond hospitalization for delayed ALND.