The value of the intraoperative assessment of the SLN via frozen section in the post Z0011 era - 22/11/20

Doi : 10.1016/j.jogoh.2020.101991

Sophocles Lanitis ^a,⁎ , Styliani Peristeraki ^a, Panagiotis Chortis ^a, Vasileios Gkanis ^a, Gionous Sourtse ^a, Miltiadis Badagionis ^a, Michalis Kontos ^b
^a 2nd surgical Department and unit of Surgical Oncology, “Korgialenio – Benakio”, Red Cross Athens General Hospital, 1 Athanasaki and Erythrou st., Athens, 11526, Greece
^b 1st surgical Department Laiko Hospital, University of Athens, 17 Agiou Thoma, Athens, 11527, Greece

^⁎Corresponding author at: 1 Athanasaki and Erythrou st., Athens, 11526, Greece.1 Athanasaki and Erythrou st.Athens11526Greece

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Highlights

•	After Z0011 the use of FS for SLN has declined and its value has been questioned.
•	Only a small group of Breast cancer patients fulfill the criteria of Z0011.
•	FN results of FS are less important today since most patients will not need ALND.
•	Frozen section (FS) can prevent reoperation in the vast majority of the patients.
•	FS if used wisely will not lead to unnecessary Axillary Dissections (ALND).

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Abstract

Introduction

Sentinel node (SN) assessment via frozen section (FS) has declined since the publication of Z0011 which modified the management of a specific group of patients with positive SN. The risk of misleading the surgeons to a preventable ALND and the cost are among the main factors for that. The aim of our study is to assess the value of FS in the post Z0011.

Material and methods

244 patients out of 434 were eligible for an upfront SLNB. Based on the final histology and the clinical data we selected the eligible for breast conserving surgery patients (55.4%). 78 patients had positive SN and 26 of them fulfilled the criteria of Z0011. We assessed the false negative findings, the impact on the management and the indications and value of FS in the post Z0011 era.

Results

Overall, there were 12 F N cases out of which 7 were macrometastases (8.97%). Only in one case there were > 2 positive LN and 3 patients needed mastectomy. The remaining cases fulfilled the criteria of Z0011 and needed no further surgery hence in 96.1% of the cases the axillary status was correctly assessed via FS and the reoperation rate was 1.2%. On the contrary, if FS was not used, at least 21.3% of the patents would have needed reoperation based on the today’s guidelines.

Discussion

We believe FS is still valuable and may spare a significant percentage of patients from a second operation (SNB) without leading to axillary overtreatment if used wisely.

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Keywords : sentinel node biopsy, frozen section, intraoperative assessment, Z0011, breast cancer