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Contemporary Evaluation of Breast Lymph Nodes in Anatomic Pathology
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Contemporary Evaluation of Breast Lymph Nodes in Anatomic Pathology
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Journal Article
Contemporary Evaluation of Breast Lymph Nodes in Anatomic Pathology
2018
Overview
Abstract
Objectives
Management of the axilla in breast cancer patients has evolved considerably since the introduction of the sentinel lymph node (SLN) biopsy in the 1990s. Several new clinical and technological developments in the last decade warrant special consideration due to their impact on pathology practice.
Methods
This review covers the SLN biopsy procedure, issues in the histopathologic and molecular diagnosis of the SLN, and most importantly, evidence from recent practice-changing clinical trials.
Results
ACOSOG Z0011, IBCSG 23-01, and AMAROS trials have shown that early-stage breast cancer patients who have limited metastatic involvement of the SLNs do not benefit from completion axillary dissections.
Conclusions
It is not necessary for pathologists to search for all small metastases to predict non-SLN involvement, regional recurrence, or death due to disease. Processing should be designed with the goal of detecting macrometastases. Multiple levels, routine immunohistochemistry, and molecular testing are not recommended.
Publisher
Oxford University Press
