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Review
. 2016 Jan;68(1):152-67.
doi: 10.1111/his.12853.

Sentinel lymph nodes for breast carcinoma: an update on current practice

Aoife Maguire  1 , Edi Brogi  1
Affiliations
Review

Sentinel lymph nodes for breast carcinoma: an update on current practice

Aoife Maguire et al. Histopathology. 2016 Jan.

Abstract

Sentinel lymph node (SLN) biopsy has been established as the standard of care for axillary staging in patients with invasive breast carcinoma and clinically negative lymph nodes (cN0). Historically, all patients with a positive SLN underwent axillary lymph node dissection (ALND). The ACOSOG Z0011 trial showed that women with T1-T2 disease and cN0 who undergo breast-conserving surgery and whole-breast radiotherapy can safely avoid ALND. The main goal of SLN examination should be to detect all macrometastases (>2 mm). Gross sectioning of SLNs at 2-mm intervals and microscopic examination of one haematoxylin and eosin-stained section from each SLN block is the preferred method for pathological evaluation of SLNs. The role and timing of SLN biopsy for patients who have received neoadjuvant chemotherapy is controversial, and continues to be explored in clinical trials. SLN biopsies from patients with invasive breast carcinoma who have received neoadjuvant chemotherapy pose particular challenges for pathologists.

Keywords: breast carcinoma; neoadjuvant chemotherapy; sentinel lymph node.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1. Measuring extracapsular extension
The dashed line represents the position of the lymph node capsule. Extracapsular extension measures 4 mm in the parallel plane and 3 mm in the perpendicular. We report the largest dimension of extracapsular extension.
Figure 2
Figure 2. Lymph node with complete pathological response to neoadjuvant chemotherapy
This patient had complete pathological response to neoadjuvant chemotherapy. A. Low power image of primary tumour bed in the breast. B. Medium power image of primary tumour bed in the breast. C. The lymph node shows marked fibrosis at low power. D. Foamy macrophages and multinucleated giant cells are present in the lymph node. The features are morphologically similar to those seen in the tumour bed in the breast.
Figure 3
Figure 3. Lymph nodes with residual metastatic carcinoma post neoadjuvant chemotherapy
A. Low power image of lymph node with residual metastastic carcinoma composed of single cells in desmoplastic stroma. Extracapsular extension is present. B. Higher power image of the same lymph node. C. Low power image of a lymph node with a subtle focus of residual carcinoma after neoadjuvant chemotherapy, seen at higher power in image D (see arrow).
See this image and copyright information in PMC

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