Intraoperative frozen section analysis can be omitted in early breast cancer without significantly elevating reoperation rates.

BACKGROUND

Sentinel lymph node biopsy remains a standard approach to treating patients with breast cancer who have no signs of obvious axillary metastases. However, fewer axillary dissections are performed today on patients with sentinel lymph node metastasis. Consequently, this has reduced the role of intraoperative frozen section analysis in decision making for axillary dissection. The aim of the present study was to evaluate the reliability of sentinel lymph node biopsy and permanent section analysis and their effects on reoperation rates in patients with early-stage breast cancer.

METHODS

Our study investigated 436 consecutive patients who had undergone operations for clinical T1-3 breast cancer with no lymph node involvement (T1-3, NO) and with sentinel lymph node analyses performed using a permanent section method. The subsequent treatment management of patients with postoperative pathology reports was examined.

RESULTS

Breast-conserving surgery was performed on 418 patients, and mastectomy was performed on 18 patients. No metastases were detected in sentinel lymph nodes in 303 (69.4%) patients, and a single lymph node metastasis was detected in 98 (22.4%) patients. Metastases were detected in two lymph nodes in 30 patients and in three or more lymph nodes in 5 patients. After evaluation, a multidisciplinary tumor board made the decision to perform axillary dissection in only 2 of these 5 patients.

CONCLUSION

Considering the low reoperation rates, permanent section analyses appear to be sufficiently safe for patients with breast cancer. Given the associated factors, such as costs, operational time, and workload, we believe that permanent section analysis should be introduced into routine implementation.

TRIAL REGISTRATION: Retrospectively registered.