Frozen section evaluation and clinicopathological correlation of sentinel lymph nodes in breast carcinoma: A study at a regional cancer centre in Western India

Abstract

Axillary lymph-node (ALN) involvement is an important prognostic factor in patients with breast carcinoma. Evaluation of Sentinel Lymph-nodes (SLN) is an accurate procedure for its assessment in the clinically node negative cases. Frozen Section Evaluation (FSE) is more widely used for intra operative evaluation of SLNs. Our study aimed to assess the sensitivity, specificity and accuracy of FSE of SLN and to compare SLN positivity with other clinico-pathological parameters. All breast carcinoma cases having FSE of SLNs were studied for a duration of two years and were compared with permanent sections. SLN positivity was also compared with other clinico-pathological parameters. A total of 281 cases were evaluated. 88 cases were positive in FSE while 92 cases were positive in permanent sections (one false-positive and five false-negatives) with sensitivity, specificity and accuracy of 94.57%, 99.47% and 97.86% respectively. SLN positivity was significantly less in T1 tumors (17.7%; p-0.005), grade I tumors (17%; p-0.040) and in triple negative tumors (15%; p-0.041). In SLN positive cases, T1 tumors showed lesser additional ALN positivity (11.11%) comparing higher T stage tumors (35.71%). FSE of SLNs in breast carcinoma has high sensitivity and accuracy. Even though Micro metastasis and ITCs are the main source of false negative rate, they do not carry much prognostic significance. SLN positivity is significantly less in T1 tumors, grade I tumors and triple negative tumors. T1 tumors with positive SLNs showed lesser additional axillary lymph-node positivity questioning their requirement for further axillary dissection.