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Frozen Section of Sentinel lymph node for Ductal Carcinoma in Situ (DCIS) Dr Cheung Chi Ying Genevieve.

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Presentation on theme: "Frozen Section of Sentinel lymph node for Ductal Carcinoma in Situ (DCIS) Dr Cheung Chi Ying Genevieve."— Presentation transcript:

1 Frozen Section of Sentinel lymph node for Ductal Carcinoma in Situ (DCIS) Dr Cheung Chi Ying Genevieve

2 Cox CE, Ann Surg SLNBx is well recognized in invasive breast cancer –avoid full axillary dissection –decrease the morbidity associated with axillary dissection Surgical techniques were well described and were mastered by many surgeons Introduction

3 SLNBx in DCIS Increasing interest of SLNBx in other applications in breast surgery –DCIS DCIS is the precursor of invasive cancer

4 Incidence of DCIS is increasing in the screening era –From 3/ to 34/ in y.o. Prognosis of pure DCIS is excellent –5 years survival >95% Van Steenbergen LN et al, breast cancer rest treat. 2009

5 Controversial issues Pre op trucut biopsy of DCIS – not 100% ! – About 29.9% of these group had upstaging of disease in final pathology WK Hung et al, Breast cancer 2009

6 Controversial issues Pure DCIS theoretically will not have any LN metastasis Management of axilla – SLNBx for F.S.? – Axillary dissection or not? – If not -> miss the invasive disease that need AD? Veronesi P et al, Breast. 2005

7 Current recommendation Selective application in high risk DCIS –Extensive microcalcifications –Palpable mass –High nuclear grade –Requiring mastectomy SLNBx is not possible as a 2nd procedure Schneider C et al, Am Surg DEredita G et al, Tumori. 2009

8 KWH experience in SLNBx for DCIS In KWH, SLNBx technique was introduced for DCIS since year 2002 Results of KWH experience of SLNBx in DCIS are being presented here

9 Patients Retrospective study Period: 3/2002 till 6/2010 Total number of patients: 170 Inclusion –Preop trucut Biopsy: DCIS

10 Patients Exclusion –Patient with microinvasive disease on trucut bx –Patients with DCIS diagnosed after OT Mean age: 54.4 years old

11 Presentation PresentationsNo.% Mammographic abnormality 11366% Breast lump4829% Nipple discharge95%

12 Operation No.% Mastectomy 12272% Mastectomy + immediate reconstruction 53% Breast conservating treatment 4325%

13 Methods of mapping Methods used for localization of SLN –Blue dye method Intra-op sub-dermal injection of Patent Blue –Isotope method Pre-op scintigraphy with 99m Tc Sulfur colloid Localization with intra-op hand-held gamma probe –Combined

14 Frozen section The sentinel LN would be sent to the laboratory immediately The pathologist would then give a verbal report –Whether the LN is positive for any macrometastasis

15 Results SLNBx was successful in 162 (95%) of patients 5 patients (3%) had +ve SLN on frozen section intraoperatively –Axillary dissection was carried out

16 Results 12 patients (7%) had false –ve FS –Axillary dissection was carried out in 6 of them

17 Pre-op core biopsy : DCIS 170 SLN Failed 8 (5%) SLN Successful 162 (95%) F.S. +ve 5 (3%) F.S. –ve 157 (92%) 3 A.D. –ve(2%) 2 A.D. +ve(1%) True –ve 145 (85%) False –ve 12 (7%) A.D. 6(3.5%) No A.D. 6 (3.5%)

18 Pre-op core biopsy : DCIS 170 SLN Failed 8 (5%) SLN Successful 162 (95%) F.S. +ve 5 (3%) F.S. –ve 157 (92%) 3 A.D. –ve(2%) 2 A.D. +ve(1%) True –ve 145 (85%) False –ve 12 (7%) A.D. 6(3.5%) No A.D. 6 (3.5%)

19 11 axillary dissections were done Only 3 of them were +ve in AD Final pathology – invasive ductal carcinoma Discussion

20 Summary SLN Successful rate95% F.S. +ve3% False –ve F.S.7% True LN +ve (ie F.S. + P.S.)10% For pure DCIS, SLN +ve4% Upstage to invasive disease27%

21 SLN Successful 162 (95%) Negative 145 (85%) Positive 17 (10%) A.D. 11 (6%) No A.D. 6 (4%) SLN for P.S. Invasive ductal CA 8 (5%) DCIS 3 (2%) All AD -ve AD –ve 5 (3%) AD +ve 3 (2%)

22 SLN Successful 162 (95%) Negative 145 (85%) Positive 17 (10%) A.D. 11 (6%) No A.D. 6 (4%) SLN for P.S. Invasive ductal CA 8 (5%) DCIS 3 (2%) All AD -ve AD –ve 5 (3%) AD +ve 3 (2%)

23 SLN Successful 162 (95%) Negative 145 (85%) Positive 17 (10%) A.D. 11 (6%) No A.D. 6 (4%) SLN for P.S. Invasive ductal CA 8 (5%) DCIS 3 (2%) All AD -ve AD –ve 5 (3%) AD +ve 3 (2%)

24 For pure DCIS with +ve sentinel lymph node – either in F.S. or paraffin section – SLN is the only LN that is +ve – rest of axilla is -ve Discussion

25 Axillary dissection and intraop frozen section for pure DCIS is unnecessary Discussion

26 For pure DCIS, taking out the SLN would be enough without the need of further axillary dissection Discussion

27 Hypothetically, if no F.S. was done for DCIS –Potentially save 162 frozen sections 3 axillary dissections Discussion

28 Thank you


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