Aims. Intraoperative analysis of the sentinel lymph node (SLN) by frozen section (FS) allows for immediate axillary lymph node dissection (ALND) in case of metastatic disease in patients with breast cancer. The aim of this study is to evaluate the benefit of intraoperative FS, with regard to false negative rate (FNR) and influence on operation time. Materials and Methods. Intraoperative analysis of the SLN by FS was performed on 628 patients between January 2005 and October 2009. Patients were retrospectively studied. Results. FS accurately predicted axillary status in 525 patients (83.6%). There were 78 true positive findings (12.4%), of which there are 66 macrometastases (84.6%), 2 false positive findings (0.3%), and 101 false negative findings (16.1%), of which there are 65 micrometastases and isolated tumour cells (64.4%) resulting in an FNR of 56.4%. Additional operation time of a secondary ALND after wide local excision and SLNB is 17 minutes, in case of ablative surgery 35 minutes. The SLN was negative in 449 patients (71.5%), making their scheduled operation time unnecessary. Conclusions. FS was associated with a high false negative rate (FNR) in our population, and the use of telepathology caused an increase in this rate. Only 12.4% of the patients benefited from intraoperative FS, as secondary ALND could be avoided, so FS may be indicated for a selected group of patients. 1. Introduction Axillary lymph node status is still considered the most important prognostic factor in patients with breast cancer. With the ongoing improvement of breast cancer screening programs, more patients are diagnosed at an earlier stage, leading to less nodal involvement. Sentinel lymph node biopsy (SLNB) has been established as a reliable method to evaluate the lymph node status of the axilla, making standard axillary lymph node dissection (ALND) unnecessary. Compared to ALND, SLNB is associated with less morbidity. Intraoperative analysis of the sentinel node by frozen section (FS) allows for immediate ALND when a metastasis is found in the sentinel node, thus avoiding a second procedure. However, among the drawbacks of FS are (1) the possibility of false negative and false positive results and (2) increase in operation time, because extra time is scheduled in advance in case the FS turns out to be positive. The sensitivity of FS has been reported to range from 58% to 76%, depending on tumour characteristics (e.g., tumour size) and the method of pathological examination [1–6]. This study was designed to evaluate the benefit of FS in our hospital, with regard to the
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