Key to the new approach is the use of sentinel lymph node biopsy (SLNB) performed as an outpatient procedure a week or so prior to mastectomy, rather then doing the SLNB at the same operation as the mastectomy and reconstruction.
According to the new study published in the October issue of the American Journal of Surgery, particular problems may arise with performing SLNB at the same time as the mastectomy with immediate reconstruction.
SLNB involves the removal of some of the first "sentinel" lymph nodes into which cancerous cells from the breast might drain. Studies have shown SLNB to be an effective way to determine the spread of disease to the lymph nodes under the arm.
In current practice using SLNB, the sentinel node is quick-frozen; a pathologist then examines the node under a microscope. This method quickly gives a diagnosis of cancer spread while the surgeon is waiting to complete the procedure. The diagnosis is confirmed a few days after surgery by a more detailed study called a permanent section.
"If the pathologist does not see tumor in the lymph node on frozen section, there is still a chance that tumor may be found in the lymph nodes on final pathology," said lead study author Dr. Nancy Klauber-DeMore, assistant professor of surgery in UNC's School of Medicine and a member of the UNC Lineberger Comprehensive Cancer Center.
"There can be major consequences for a patient who has undergone immediate breast reconstruction if a metastasis is found on permanent section that was not recognized on frozen section."
There are two issues here, Klauber-DeMore said. The first is the need for another operatio
Contact: L. H. Lang
University of North Carolina School of Medicine