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New Method for Sentinel Lymph Node Evaluation Improves Sensitivity in Detection of Breast Cancer Metastasis: Presented at ASCP By Lexa W. Lee NEW ORLEANS, LA -- October 25, 2007 -- Detection of breast cancer metastases is significantly improved using a new method to evaluate sentinel lymph nodes (SLNs), as demonstrated by researchers at the annual meeting of the American Society of Clinical Pathology (ASCP). Using SLNs as an indicator of non-sentinel axillary node involvement by metastatic breast cancer, immediate axillary lymph node dissection (ALND) can be performed if metastasis is detected during intraoperative consultation (IOC). The surgical benefit depends on the sensitivity of IOC for detecting metastases. ALND is usually performed as a second procedure in the case of false-negative SLNs. Brad Wheeler, MD, Resident Pathologist, University of Arizona in Tucson, Arizona, United States, and colleagues had been using SLN bisection and a random cytologic sampling method for evaluation during IOC. The sensitivity of this procedure for detecting breast cancer metastasis was similar to the current literature (49%), according Dr. Wheeler. A new method, devised by the research team in an effort to improve IOC sensitivity, involves a 2-mm longitudinal slicing of SLNs and careful gross evaluation for small-size macrometastases of 2 mm. Frozen section of any candidate foci are then evaluated histologically. "This was basically a policy of a more thorough examination for gross evaluation during IOC," said Dr. Wheeler. "We were able to give more information to the surgeon." The study compared 150 IOC cases evaluated using the standard method and 33 IOC cases evaluated using the new method. The new method resulted in improvements in the following areas: overall accuracy (97% vs 85%); detection sensitivity (95% vs 49%); detection sensitivity for macrometastases (100% vs 61%); gross identification of macrometastases (5% vs 11%); and benefit of immediate non-sentinel ALND (92% vs 55%). "We will continue to add cases [using the new method] to establish a more solid base of actual numbers," Dr. Wheeler said. "Maybe this will change the way people are doing intraoperative consultations." [Presentation title: Breast Sentinel Lymph Nodes: Improved Method for Intraoperative Evaluation. Poster 84] E-mail this page to a friend or colleague! To print, use this version