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Lin SE, Chang WW, Hsiao PK, Hsieh MC, Chen WY, Fang CL, Tsai CC. Feasibility of Breast Cancer Metastasis Assessment of Ex Vivo Sentinel Lymph Nodes through a p-H&E Optical Coherence Microscopic Imaging System. Cancers (Basel) 2022; 14:cancers14246081. [PMID: 36551567 PMCID: PMC9776820 DOI: 10.3390/cancers14246081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/21/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Frozen-sectioned hematoxylin-eosin (H&E) image evaluation is the current method for intraoperative breast cancer metastasis assessment through ex vivo sentinel lymph nodes (SLNs). After frozen sectioning, the sliced fatty region of the frozen-sectioned specimen is easily dropped because of different freezing points for fatty tissues and other tissues. Optical-sectioned H&E images provide a nondestructive method for obtaining the insight en face image near the attached surface of the dissected specimen, preventing the freezing problem of fatty tissue. Specimens from 29 patients at Wanfang Hospital were collected after excision and were analyzed at the pathology laboratory, and a fluorescence-in-built optical coherence microscopic imaging system (OCMIS) was then used to visualize the pseudo-H&E (p-H&E) images of the SLNs for intraoperative breast cancer metastasis assessment, and the specificity, sensitivity, and accuracy were 100%, 88.9%, and 98.8% (n = 83), respectively. Compared with gold-standard paraffin-sectioned H&E images, the specificity, sensitivity, and accuracy obtained with the frozen-sectioned H&E images (n = 85) of the specimens were the same as those obtained with the p-H&E images (n = 95). Thus, OCMIS is a useful noninvasive image-assisted tool for breast cancer metastasis assessment based on SLN images.
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Affiliation(s)
- Sey-En Lin
- Department of Anatomic Pathology, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 23652, Taiwan
- Department of Pathology, Taipei Medical University Hospital, Taipei Medical University, Taipei 11031, Taiwan
- Department of Pathology, Wanfang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Wei-Wen Chang
- Division of General Surgery, Department of Surgery, Wanfang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Ping-Kun Hsiao
- Division of General Surgery, Department of Surgery, Wanfang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Mao-Chih Hsieh
- Division of General Surgery, Department of Surgery, Wanfang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Wei-Yu Chen
- Department of Pathology, Wanfang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Chia-Lang Fang
- Department of Pathology, Taipei Medical University Hospital, Taipei Medical University, Taipei 11031, Taiwan
- Department of Pathology, Wanfang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Chien-Chung Tsai
- AcuSolutions Inc., 3F., No. 2, Ln. 263, Chongyang Rd., Nangang Dist., Taipei 11573, Taiwan
- Correspondence: ; Tel.: +886-2-2558-9611
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Si J, Guo R, Pan H, Lu X, Guo Z, Han C, Xue L, Xing D, Wu W, Chen C. Axillary Lymph Node Dissection Can Be Omitted in Breast Cancer Patients With Mastectomy and False-Negative Frozen Section in Sentinel Lymph Node Biopsy. Front Oncol 2022; 12:869864. [PMID: 35494089 PMCID: PMC9046780 DOI: 10.3389/fonc.2022.869864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/14/2022] [Indexed: 11/15/2022] Open
Abstract
Background The IBCSG 23-01 and AMAROS trials both reported that axillary lymph node dissection (ALND) did not change survival rates in breast cancer patients with positive nodes detected by sentinel lymph node biopsy (SLNB). The aim of this study was to determine whether breast cancer patients with mastectomy and false-negative frozen section (FS) in SLNB could forgo ALND. Materials and Methods This was a retrospective study of cN0 patients diagnosed with primary invasive breast cancer treated by mastectomy and SLNB at our institute between January 2010 and December 2014. Patients with false-negative FS in SLNB were separated by the following management of axillary lymph node dissection in the non-ALND group (nonprocess or axillary radiation only) and ALND group (with or without radiation). Results A total of 212 patients were included, 86 and 126 patients in the non-ALND and ALND groups, respectively. The positive rate of non-sentinel lymph nodes (SLNs) was 15.87% (20/126) in the ALND group. In multivariate analysis, we found that patients with larger tumor size (>2 cm) (OR, 1.989; p = 0.030) and multifocal lesions (OR, 3.542; p = 0.029) tended to receive ALND. The positivity of non-SLNs in the ALND group was associated with SLN macrometastasis (OR, 3.551; p = 0.043) and lymphovascular invasion (OR, 6.158; p = 0.003). Also, removing more SLNs (≥3) was related to negativity in non-SLNs (OR, 0.255; p = 0.016). After a median follow-up of 59.43 months, RFS and OS of the two groups were similar (p = 0.994 and 0.441). In subgroup analysis, we found that 97 patients who met the inclusive criteria of the IBCSG 23-01 trial had similar RFS and OS between the non-ALND and ALND groups (p = 0.856 and 0.298). The positive rate of non-SLNs was 9.62% (5/52). Also, in 174 patients who met the criteria of the AMAROS trial, RFS and OS in the non-ALND and ALND groups were similar (p = 0.930 and 0.616). The positive rate of non-SLNs was 18.27% (19/104). Conclusion ALND can be carefully omitted in selected breast cancer patients with mastectomy and false-negative FS in SLNB. SLNB is relatively sufficient in the IBCSG 23-01-eligible patients, and axillary radiation was an effective option in the AMAROS-eligible patients.
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Affiliation(s)
- Jing Si
- Department of Breast Disease, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
- Cancer Research Center, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
- *Correspondence: Jing Si,
| | - Rong Guo
- Department of Breast Surgery, Breast Cancer Center of the Third Affiliated Hospital of Kunming Medical University, Cancer Hospital of Yunnan Province, Kunming, China
| | - Huan Pan
- Department of Central Laboratory, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xiang Lu
- Department of Breast Disease, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Zhiqin Guo
- Department of Pathology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chao Han
- Department of Breast Disease, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Li Xue
- Department of Breast Disease, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Dan Xing
- Department of Breast Disease, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Wanxin Wu
- Department of Pathology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Caiping Chen
- Department of Breast Disease, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
- Cancer Research Center, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
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