Evaluation of the axilla and current standards of pathological work-up

The axillary sentinel node biopsy has emerged recently as a most useful procedure to stage patients with small primary breast carcinomas and clinically uninvolved axillary nodes, and to guide therapy with minimal morbidity. Indeed, the histological examination of axillary sentinel nodes is highly predictive of the nonsentinel axillary node status and may spare axillary clearing in patients with histologically uninvolved sentinel nodes. To avoid the need for two separate surgical sessions the results of sentinel node examination may be known intraoperatively. Routine frozen section examination of sentinel nodes, however, is liable to yield false-negative results. An extensive intraoperative examination of frozen sentinel nodes, which would attain a sensitivity comparable to that obtained by routine histological analysis, has been therefore devised. To facilitate the detection of micrometastatic disease in the sentinel nodes. immunocytochemical and molecular biology techniques can be adopted. Indeed, the identification of specific epithelial antigens or mRNA markers may be useful adjuncts to the histological examination of the sentinel nodes. (C) 2001 Harcourt Publishers Ltd.