Assessment of the Efficacy of Frozen Section Examination as an Intraoperative Tool in Detecting Metastasis of Axillary Lymph Node in Early Breast Cancer: A Tertiary Centre Experience

Sentinel lymph node biopsy is the gold standard for axillary assessment in patients with clinically node negative breast cancer. Further management depends upon the histologic status of the retrieved sentinel nodes. Therefore, authors have been developing and searching for an accurate intraoperative method to detect or exclude metastasis in these nodes. Internationally accepted intraoperative assessment tools include frozen section, imprint cytology and molecular analysis. However, variable results derived from these studies led to a debate about which is the most reliable test. Therefore, we planned our study to assess the sensitivity and specificity of frozen section examination as it is still the most common practice in many centres especially in developing countries including Egypt. All were subjected to sentinel lymph node biopsy using both 1% patent blue dye and radioactive nanocolloid (combination technique). The retrieved sentinel nodes were sent for intraoperative frozen section evaluation which was later confirmed by the permanent paraffin section. The resultant sentinel node identification rate was 93.4%. Our case series analysis involved 458 patients with clinically negative early breast cancer. The study revealed that intraoperative frozen section had a specificity of 100% (0% false positive cases). However, it failed to detect micrometastasis in 7 of these patients (0.9% false negative) producing a 95.6% sensitivity (P value < 0.001). Based on the forementioned results and the previous studies’ reports, we believe that the frozen section examination is a reliable assessment tool in intraoperative axillary staging with a high accuracy rate.