Evaluation of Intraoperative Frozen Section with Final Histopathology Results for Sentinel Lymph Node Biopsy in Breast Cancer

Background: Intraoperative assessment of sentinel lymph nodes for patients undergoing surgery for early breast cancer has the potential to reduce the need for delayed axillary lymph node dissection (ALND), significantly reducing patient morbidity, expediting adjuvant therapy, reducing length of hospital stay and cost of hospitalisation. This study aims to evaluate intraoperative frozen section in identifying cancerous involvement of sentinel lymph nodes in early breast cancer. Materials and Methods: The frozen section and final histopathology reports of 104 consecutive patients undergoing surgery for early breast cancer with sentinel lymph node biopsy between May 2016 and June 2017 were assessed. Results: Intraoperative frozen section has a sensitivity and specificity of 89.7 (75.8–97.1%, p ≤ 0.05) and 100%, respectively, with a negative predictive value of 94.1 (86.3–97.6%, p ≤ 0.05) in identifying metastasis to sentinel node. The sensitivity of frozen section is lowered by its inability to accurately pick up micrometastasis. However, frozen section is highly accurate in picking up macrometastasis with a sensitivity of 100%. Conclusion: Intraoperative frozen section, when performed as per CAP guidelines, can identify macrometastasis to sentinel lymph nodes with a very high sensitivity in early breast cancer. Its routine use in early breast cancer can reduce the need for second procedure, in the form of delayed ALND. © 2017, Association of Gynecologic Oncologists of India.