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Accuracy of Intraoperative Frozen Section of Sentinel Lymph Nodes After Neoadjuvant Chemotherapy for Breast Carcinoma

Grabenstetter, Anne MD*; Moo, Tracy-Ann MD; Hajiyeva, Sabina MD*; Schüffler, Peter J. DrSc*; Khattar, Pallavi MD*; Friedlander, Maria A. MPA, CT(ASCP)*; McCormack, Maura A. BS*; Raiss, Monica BA; Zabor, Emily C. DrPH; Barrio, Andrea MD; Morrow, Monica MD; Edelweiss, Marcia MD*

The American Journal of Surgical Pathology: October 2019 - Volume 43 - Issue 10 - p 1377–1383
doi: 10.1097/PAS.0000000000001311
Original Articles
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False-negative (FN) intraoperative frozen section (FS) results of sentinel lymph nodes (SLN) have been reported to be more common after neoadjuvant chemotherapy (NAC) in the primary surgical setting. We evaluated SLN FS assessment in breast cancer patients treated with NAC to determine the FN rate and the histomorphologic factors associated with FN results. Patients who had FS SLN assessment following NAC from July 2008 to July 2017 were identified. Of the 711 SLN FS cases, 522 were negative, 181 positive, and 8 deferred. The FN rate was 5.4% (28/522). There were no false-positive results. Of the 8 deferred cases, 5 were positive on permanent section and 3 were negative. There was a higher frequency of micrometastasis and isolated tumor cells in FN cases (P<0.001). There was a significant increase in tissue surface area present on permanent section slides compared with FS slides (P<0.001), highlighting the inherent technical limitations of FS and histologic under-sampling of tissue which leads to most FN results. The majority (25/28, 89%) of FN cases had metastatic foci identified exclusively on permanent sections and were not due to a true diagnostic interpretation error. FN cases were more frequently estrogen receptor positive (P<0.001), progesterone receptor positive (P=0.001), human epidermal growth factor receptor-2 negative (P=0.009) and histologic grade 1 (P=0.015), which most likely reflects the lower rates of pathologic complete response in these tumors. Despite its limitations, FS is a reliable modality to assess the presence of SLN metastases in NAC treated patients.

Departments of *Pathology

Surgery

Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY

Conflicts of Interest and Source of Funding: P.J.S. is a cofounder of Paige.AI. The remaining authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Anne Grabenstetter, MD, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (e-mail: grabensa@mskcc.org).

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