Clinical research of intraoperative frozen sections plus rapid immunohistochemistry staining in detection of sentinel lymph node micrometastasis of breast cancer

Objective To investigate the diagnostic value of intraoperative frozen sections plus rapid immunohistochemistry staining in detecting sentinel lymph nodes(SLNs) micrometastases of breast cancer, and analyse the relation between SLNs micrometastases and clinical factors. Methods Forty-three breast cancer patients underwent sentinel lymph node biopsy (SLNB). The intraoperatively resected SLNs were sent for rapid pathological examination. Serial sections at a 100 μm interval, HE staining of frozen sections and rapid immunohistochemistry staining were done to detect SLNs micrometastases and test the expressions of pan-cytokerain(pan-CK) and epithelial membrane antigen (EMA). Chi-square test or correction chi-square test was used for statistical analysis. Results SLNB was successful for the 43 breast cancer patients. A total of 100 SLNs were detected. Four cases were detected with cancer metastases by HE staining of frozen sections. Thirty-nine cases with negative HE staining were continuously detected with rapid immunohistochemistry staining examination, of them 6 were detected with micrometastases. The detection rate of SLNs metastases was 9.3%(4/43)by HE staining of frozen sections, but was 23.3%(10/43) by frozen sections plus intraoperative rapid immunohistochemistry staining. The sensitivity, specificity, coincidence rate and false negative rate for HE staining of frozen sections and frozen sections plus intraoperative rapid immunohistochemistry staining were 36.4% and 90.9%, 100% and 100%, 83.7% and 97.7%, and 63.6% and 9.1%, respectively. There was no significant correlation between the SLNs micrometastases and menstrual status, tumor stage, histological type, tumor location, hormone receptor status and HER-2 status (P0.05). Conclusion Intraoperative frozen sections plus rapid immunohistochemistry staining can increase the detection rate of SLNs micrometastases and reduce the false negative rate. It is safe, rapid, and low-costly. We recommend this method in clinical application.