Evaluation of the axilla and current standards of pathological work-up

The axillary sentinel node biopsy has emerged recently as a most useful pro cedure to stage patients with small primary breast carcinomas and clinicall y uninvolved axillary nodes, and to guide therapy with minimal morbidity. I ndeed, the histological examination of axillary sentinel nodes is highly pr edictive of the nonsentinel axillary node status and may spare axillary cle aring in patients with histologically uninvolved sentinel nodes. To avoid t he need for two separate surgical sessions the results of sentinel node exa mination may be known intraoperatively. Routine frozen section examination of sentinel nodes, however, is liable to yield false-negative results. An e xtensive intraoperative examination of frozen sentinel nodes, which would a ttain a sensitivity comparable to that obtained by routine histological ana lysis, has been therefore devised. To facilitate the detection of micrometastatic disease in the sentinel node s. immunocytochemical and molecular biology techniques can be adopted. Inde ed, the identification of specific epithelial antigens or mRNA markers may be useful adjuncts to the histological examination of the sentinel nodes. ( C) 2001 Harcourt Publishers Ltd.