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The optimal management of the axillae of patients with microinvasive breast cancer in the sentinel lymph node era.

Gray RJ, Mulheron B, Pockaj BA, Degnim A, Smith SL

Department of General Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA. gray.richard@mayo.edu

BACKGROUND: For patients with microinvasive breast cancer, the value of intraoperative analysis of sentinel lymph nodes (SLNs) and complete axillary lymph node dissection (CALND) is not well known. METHODS: All patients staged T1mic from 2001 to 2005 were analyzed. RESULTS: Among all 81 patients, 4 (5%) had SLN metastases detected with hematoxylin and eosin staining and 2 (2%) had metastases identified by immunohistochemistry staining only. Seventy-seven patients (95%) underwent SLN biopsy; 3 (4%) had hematoxylin and eosin SLN metastases and 2 (3%) had immunohistochemistry-detected metastases. One SLN metastasis was identified on frozen section analysis. No patient with a SLN metastasis had additional metastases on CALND. The patient charges for frozen section analyses were $39,578 for 77 patients. This prevented 1 reoperative CALND at a charge of $20,274. CONCLUSIONS: Frozen section analysis should be used only in select patients with microinvasive breast cancer and CALND is of limited value for these patients.

Published 16 November 2007 in Am J Surg, 194(6): 845-8; discussion 848-9.
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