Introduction[]
- Done to allow breast conservation therapy in patients with invasive carcinoma <2 cm (T1 lesion).
- In skilled hands, greater than 98% accurate in identifying sentinel nodes.
- Usually only a single node. In a small percent of cases the sentinel node may be a small group of two or three nodes.
- Should not be receiving more than three on a regular basis. If surgeon does not rapidly identify node, the radiotracer spreads into non-sentinel nodes and this causes the node count to increase.
- The nodes may be designated “hot” (meaning radiotracer was found in the node” and/or “blue” (meaning dye was found in the node). These are handled identically and the designation has no significance to the pathologist.
- The specimens are radioactive, but the dose to the pathologist in one study was below the limit of detection (Klausen TL, Clin Physiol Funct Imaging 2005 Jul;25(4):196-202).
Fresh Handling[]
Fix in formalin.
Note: The surgeons may occasionally request a frozen section on a sentinel lymph node. This is no longer standard, but it is not wrong. AE1/3 stain has been validated on previously frozen tissue.
Grossing In[]
- Dissect specimen to identify nodes. Describe number and maximal size.
- Bisect each node. Describe any grossly identifiable disease.
- Submit specimen in toto.
- Bisected nodes should go in their own cassette(s) so that the two halves can be put back together.
- Alternative approach: ink nodes in different colors to allow the halves to be matched up (“differential inking”).
- Grossly positive nodes do not need to be submitted in toto. One section, including any area suspicious for extracapsular extension, is sufficient.
- Preorder AE1/3 stain on all nodes.
- SLNs may occasionally be accompanied by other nodes designated as “non-sentinel lymph node”. These should be submitted in toto, but do not need to be bisected and do not require AE1/3 stain.
Sample Dictation[]
The specimen consists of a portion of tan-yellow fatty tissue measuring ___ x ___ x ___ cm, dissected to reveal ___ potential lymph nodes measuring up to ___ cm in greatest dimension, containing blue dye. The nodes are bisected, showing no gross evidence of disease. The bisected nodes are submitted in ___. AE1/3 stain is preordered.
Review and Signout[]
1. Sentinel lymph node, right axilla, biopsy:
2. Sentinel lymph node #2, right axilla, biopsy:
3. Non-sentinel lymph node, left axilla, biopsy:
- ___ lymph nodes, no tumor seen (0/___).
- Metastatic carcinoma (___ cm focus) present in one out of ___ lymph nodes (1/___), without extracapsular extension.
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