Abstract
Aim
To investigate whether omitting intra-operative staging of the sentinel lymph node
(SLN) in T1-N0 breast-cancer patients is feasible and convenient because it could
allow a more efficient management of human and logistic resources without leading
to an unacceptable increase in the rate of delayed axillary lymph node dissection
(ALND).
Methods
According to the experimental procedure, T1a–T1b-patients were to not receive any
intra-operative SLN evaluation on frozen sections (FS). In all T1c-patients, the SLN
was macroscopically examined; if the node appeared clearly free of disease, no further
intra-operative assessment was performed; if the node was clearly metastatic or presented
a dubious aspect, the pathologist proceeded with analysis on FS. T2-patients, enrolled
in the study as reference group, were treated according to the institutional standard
procedure; they all received SLN staging on FS.
Results
The study included 395 T1-N0-patients. Among the 118 T1a–T1b-patients whose SLN was
not analyzed at surgery, 12 (10.2%) were recalled for ALND. In the group of 258 T1c-patients,
112 received SLN analysis on FS and 146 did not. An SLN falsely negative either at
macroscopic or FS examination was found in 33 (12.8%) cases. Overall, the rate of
recall for ALND was 11.6% as compared to 8.4% in T2-patients. Using the experimental
protocol, the institution reached a 9.6% cost saving, as compared to the standard
procedure.
Conclusions
Omission of SLN intra-operative staging in T1-N0-patients is rather safe. It provides
the institution with both management and economical advantages.
Keywords
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Article info
Publication history
Accepted:
June 7,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
