CORRELATION BETWEEN HISTOPATHOLOGICAL DIAGNOSIS AND THE INTRAOPERATIVE FREEZING METHOD OF SENTINEL LYMPH NODE IN BREAST CANCER

• DOI: >https://doi.org/10.22533/at.ed.1594252411036

• Palavras-chave: Breast neoplasms; Lymphatic Metastasis; False negatives; Frozen tissue sections; Radical axillary lymphodectmonia.

• Keywords: Breast neoplasms; Lymphatic Metastasis; False negatives; Frozen tissue sections; Radical axillary lymphodectmonia.

• Abstract:

  The study of the sentinel lymph node using the intraoperative freezing method has proven to be an important ally in the management of patients with breast cancer, as it identifies the need for radical axillary lymph nodeectomy, a complex surgery associated with high rates of morbidity, in addition to a worse prognosis. Subsequently, the sentinel lymph nodes are reevaluated using the histopathological method to definitively confirm the presence or absence of metastasis. Given this assumption, the study aims to correlate the result of the freezing method with the histopathological report, aiming to define the sensitivity and specificity of the freezing section when compared to the gold standard diagnosis. This was a qualiquantitative, descriptive study, using secondary cross-sectional data from one year. The sample consisted of 93 female patients, over 18 years old, diagnosed with breast cancer, who underwent the lymph node freezing method at this service. The study was approved by the Human Research Ethics Committee, substantiated opinion no. 4,976,455 of September 15, 2021. All data analyzed showed that patients with breast cancer underwent the sentinel intraoperative freezing method. lymph node. The average age at diagnosis was 56 years, with a range from 32 to 85 years. 20.4% of patients had a palpable lymph node in the physical examination at the first consultation and 35 patients had metastasis, corresponding to 37.6% of the sample, with lymph node metastasis was detected in 32 of these patients. Bone, liver, lung and even brain metastases were also identified, all with a poor prognosis. Staging of breast cancer, using the TNM as a parameter, 24 patients were classified as IA, 30 as IIA and 19 as IIB. Only 4 patients had distant metastasis, and were therefore classified as stage. IV. The remaining metastases were from lymph nodes close to the original tumor. Regarding the intraoperative sentinel lymph node freezing test compared with the histopathological method, 19 true positive results (20.4%) and 14 false negative results (15.1%) were observed, which gives the freezing test a sensitivity of 57% for this sample and specificity of 100%, that is, all positive results from the frozen section test were confirmed by histopathology, but there was a high rate of false negatives (p<0.05). Of the 14 false-negative results for metastasis in the frozen section test, 5 were due to micrometastasis (35.7%). All patients diagnosed with micrometastasis presented a false negative test. The data analyzed in this sample corroborates the relevance that there is a correlation between the result of the freezing method and the histopathological report between the presence of micrometastases and false negative results in this type of tumor. However, there was no statistical significance between histological subtype, immunohistochemistry and false negative results. It was observed that the lobular subtype has a worse prognosis than the Invasive ductal subtype due to its greater relationship with metastases and more advanced staging. It was possible to observe the impact that the frozen section test has on the choice of the type of surgery, almost all patients with a positive frozen section test had surgical treatment complemented with radical lymphadenectomy, while patients with a negative frozen section underwent quadrantectomy or even mastectomy without lymph node emptying, less invasive surgeries.