Clinical Study Of Occult Metastases In Sentinel Lymph Node In Breast Cancer

Objective: To investigate the diagnostic efficacy of ultrasonography in patients with negative intraoperative sentinel lymph frozen section diagnosis but positive postoperative paraffin pathological diagnosis.Methods: The breast cancer patients who underwent sentinel lymph node biopsy at the Breast Center of the Fourth Hospital of Hebei Medical University from September 2017 to October 2018 were selected for the study.Investigate the accuracy of the intraoperative frozen section pathologic diagnosis in SLNB.The cases which had negative frozen sections results while the postoperative pathologic results were macrometastasis,micrometastasis,and isolated tumor cells were given a detailed study.Results: From September 2017 to October 2018,there were 1231 cases who underwent SLNB following the detection of SLN in the breast center of the Fourth Hospital of Hebei Medical University.145 cases had already done mass recection and 38 cases had received neoadjuvant treatment.There were 1048 patients after excluding these cases from 1231 cases.Of these 1048 cases,frozen sections of the SLN were positive in 127 cases with the positive rate of 12.1% and negative in 921 cases with the negative rate of 87.9%.There were 89 cases(9.7%)of Occult metastasesamong those 921 cases.These occult metastases cases included 27(30.3%)macrometastases,51(57.3%)micrometastases,and 11(12.4%)isolated tumor cells.The intraoperative frozen section diagnosis false negative rate was defined as the proportion of SLN occult metastases cases in the cases with positive postoperative pathologic diagnosis.In this study,the FNR was 43.4 %(89/205).When compared SLN's frozen section pathologic results with its postoperative pathologic results in 1048 patients,the accuracy rate of SLNB was 91.5%.The different metastase states of occult metastases have no connection with the tumor size(P=0.406).The lymph nodes with metastatic characters were not found in the axillary ultrasound of the enrolled cases.Only 20 patients(22.5%)' ALNs were found to have thicker cortex.There were no statistically significant differences between different occult metastases states and ultrasound findings(P = 0.350).Conclusion: Intraoperative frozen section diagnosis of SLNB can generally evaluate the status of sentinel lymph nodes accurately.Only a small number of patients who have occult metastases.Occult metastases of SLN have no correlation with tumor size.And ultrasound does not have diagnostic efficiency for these patients.