Langer I, Guller U, Berclaz G et al.
University Hospital Basel, Basel, Switzerland.
Breast Cancer Res Treat 2009;113:129–36.
Editor’s note: Sentinel lymph node biopsy (SLNB) accurately determines the status of the axillary lymph nodes (ALNs) and has become the new standard of care for clinically node-negative breast cancer patients. First introduced in specialized, academic centers, the SLNB is now routine practice in the surgical therapy of breast cancer patients in non-academic clinics and community hospitals. However, the value of intraoperative frozen section of the SLN remains controversial. Frozen section has the clear advantage of sparing patients with a positive SLN from undergoing a second operation. On the other hand, some physicians perceive this procedure to be time-consuming, costly, associated with potential tissue loss, and inaccurate in the detection of metastatic deposits. Therefore, the objective of the present prospective, multicenter study was to test two hypotheses: firstly, that frozen section is highly accurate in the detection of SLN macrometastases, avoiding a delayed completion ALN dissection (ALND); and secondly, that most patients with a negative frozen section result but positive final histopathology owing to micrometastases or isolated tumor cells do not benefit from further axillary surgery.