A Study on Sentinel Node and Occult Lesion Localisation: Do We Really Need an Intraoperative Frozen Examination?/ Sentinel Nod ve Okult Lezyon Lokalizasyonunda Intraoperatif Frozen Degerlendirme Gerekli midir?

• Published in: Istanbul medical journal Vol. 21; no. 4; p. 312
• Main Authors: Ulusan, Kivilcim, Ulusan, Melis Baykara, Velidedeoglu, Mehmet, Ozturk, Tulin, Sahin, Onur Erdem, Ferahman, Sina, Ferahman, Mehmet
• Format: Journal Article
• Language: English; Turkish
• Published: Galenos Yayinevi Tic. Ltd 01.07.2020; AVES
• Subjects: Analysis; Lumpectomy; Radiosurgery; Surgical clinics; Tumor removal
• ISSN: 2619-9793; 1304-8503
• DOI: 10.4274/imj.galenos.2020.60430

Introduction: The sentinel node and occult lesion localisation (SNOLL) technique combines radio-guided occult lesion localisation and sentinel lymph node biopsy (SLNB) using radioisotopes. In addition to the success of the SNOLL procedure, we investigated the efficacy and necessity of intraoperative frozen pathology in terms of clear margins and reinterventions in non-palpable breast lesions (NPBLs). Methods: The study was conducted at a single centre, in a general surgery clinic between 2006-2016. The medical records of 83 patients with NPBLs and negative axillae were acquired. Before surgery, patients were administered peritumoral and subdermal radionuclide tracer at the axillary region. All the patients underwent breast-conserving surgery and SLNB using a gamma probe following SNOLL. Results: A malignancy was detected in 78 of 83 lesions. Analyses of intraoperative frozen sections showed that the surgical margins were clear in 35 (44.9%), close in 17 (21.7%), and involved in 26 (33.3%) patients. Patients in the latter two groups underwent intraoperative re-excision of the tumour. On the final paraffin sections, surgical margin positivity was determined in seven (9%) patients. Sentinel lymph nodes (SLNs) were detected successfully in 77 of 78 patients (98.7%). The overall success rate of the SNOLL procedure was 88.5% (69/78) in patients surgically treated in a single operation. Intraoperative re-excision was beneficial in only 3 of 78 (3.8%) patients. Conclusion: SNOLL is a feasible, simple, and time-saving method for localising non-palpable breast cancers and SLNs. However, the contribution of margin assessment using frozen sections to the success of the method is limited. Keywords: Sentinel lymph node, sentinel node and occult lesion localisation (SNOLL), non-palpable breast cancer, radio-guided surgery, radio-guided occult lesion localisation (ROLL) Amac: Sentinel nod ve okult lezyon lokalizasyonu (SNOLL), radyonuklid okult lezyon lokalizasyonu ve sentinel lenf nodu biyopsisinin (SLNB) birlikte kullanildigi tekniktir. Calismamizda SNOLL isleminin basarisinin yani sira palpe edilemeyen meme lezyonlarinda cerrahi sinir pozitifligi ve tekrar girisim acisindan intraoperative dondurulmus patoloji gerekliligi ve yararliligini da arastirdik. Yontemler: Calisma 2006-2016 yillari arasinda tek merkezde genel cerrahi klinigimizde yapilmistir. Palpe edilemeyen meme lezyonu olan aksillasi negatif 83 hastani kayitlari kullanilmistir. Cerrahiden once tum hastalara peritumoral ve aksilla bolgesinde subdermal radyonuklid enjekte edilmistir. Tum hastalara SNOLL prosedurunu takiben gama prob yardimi ile meme koruyucu cerrahi ve SLNB uygulanmistir. Bulgular: Seksen uc hastanin 78'inde malignite tespit edilmistir. Intraoperatif dondurulmus incelemede 35 (%44,9) hastada cerrahi sinir negatif, 17 hastada (%21,7) yakin cerrahi sinir ve 26 (%33,3) hastada cerrahi sinir pozitif olarak gelmistir. Son iki gruptaki hastalara intraoperatif tumor reeksizyonu yapilmistir. Nihai paraffin incelemede 7 (%9) hastada cerrahi sinir pozitifligi tespit edilmistir. Sentinel lenf nodlari (SLN)'ler 78 hastanin 77'sinde (%98,7) basari ile tespit edilebilmistir. Tek operasyon ile tedavi edilen hastalarda SNOLL prosedurunun genel basarisi %88,5'tir (69/78). Intraoperatif reeksizyon hastalarin sadece ucunde (%3,8) fayda saglamistir. Sonuc: SNOLL; palpe edilemeyen meme kanserlerinde ve SLN'lerin lokalizasyonunda kolay uygulanabilen, basit ve zaman kazandirici bir yontemdir. Ancak dondurulmus inceleme ile cerrahi sinir degerlendirmesinin yontemin basarisina olan katkisi sinirlidir. Anahtar Kelimeler: Sentinel lenf nodu, sentinel lenf nodu ve okult lezyon lokalizasyonu (SNOLL), non-palpabl meme kanseri, radyonuklid isaretleme, radyonuklid okult lezyon lokalizasyonu (ROLL)