Evaluation of the Benefit of Intraoperative Frozen Section Analysis of Sentinel Lymph Nodes in Clinically Negative Node Early Breast Cancer after ACOSOG Z0011 Era
Keywords:
early breast cancer, frozen section, sentinel lymph nodeAbstract
Background: Sentinel lymph node (SLN) biopsy (SLNB) is the standard practice for patients with clinically negative axillary lymph node. Frozen section was used to reduce the rate of re-operation in the case of sentinel lymph node (SLN) positive. From ACOSOG Z0011 and AMAROS trials, they supported that axillary lymph node dissection (ALND) can be omitted in selected patients. Globally, frozen section has been decreased significantly.
Objective: To determine the re-operative rate in the patient that limited SLN metastasis treated following ACOSOG Z0011 and determine factors that associated with metastatic involvement of axillary lymph nodes (ALN).
Material and Method: Patients who diagnosed early breast cancer with clinically node negative were retrospectively reviewed. All patients were initial treated with total mastectomy, lumpectomy, ALND and SLNB from 2014 to 2018 were collected. Demographic data was recorded, re-operative was calculated and the risk of metastasis to ALN were analyzed in relation to clinicopathological determinants.
Result: 190 patients were enrolled in this study. 19 patients (10%) required ALND. Factors associated with ALN metastasis in univariate analyses were age >50 year, HER-2 expression, lymphovascular invasion (LVI), and extra nodal extension. All factors identified with univariate analyses were entered into a multivariate logistic regression model and HER-2 expression (OR=2.42, p=0.006), LVI (OR=3.53, p<0.001) and extra nodal extension (OR=8.11, p= 0.008) remained as independent factors of ALN metastasis.
Conclusion: The chances of having to re-operation are relatively low following ACOSOG Z0011. HER-2 expression, LVI and extra nodal extension are factors that associated with ALN metastasis in patient with early breast cancer.
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