ArticleAnnals of surgical oncology2025
Omission of Routine Frozen Section for Clinically Node-Negative Patients Undergoing Upfront Mastectomy Avoids Unnecessary Axillary Treatment.
Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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1 citing paper in PubMed.
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Authors and funding
6 authors.
Funding
Abstract
backgroundRandomized trials established the safety of postmastectomy radiation/regional nodal irradiation (PMRT) as an alternative to axillary lymph node dissection (ALND) for cN0 patients undergoing upfront mastectomy with one or two positive sentinel lymph nodes (+SLNs). In January 2022, the authors adopted a policy omitting routine frozen section for cT1-3N0 patients undergoing upfront mastectomy, and this study sought to examine the impact of this policy on axillary treatment.
methodsConsecutive patients with cT1-3N0 breast cancer who underwent upfront mastectomy from January 2022 to July 2023 were identified. For patients with three or more +SLNs and those with one or two +SLNs not meeting institutional PMRT criteria, ALND was indicated. This study evaluated ALND/PMRT rates after adoption of this policy.
resultsIn this study, 623 patients with cT1-3N0 breast cancer had upfront mastectomy with sentinel lymph node biopsy. Overall, 4.7% (n = 29) of the patients had completion ALND (cALND). These patients had larger tumors, and more often had lobular histology and LVI. Of 98 patients with one or two +SLNs, 86 (88%) underwent PMRT and no further surgery, and 8 (8%) had ALND due to no initial PMRT indication, of whom 2 then met PMRT criteria based on additional positive nodes, and 4 had neither. Among those with three or more +SLNs (n = 29), 21 (72%) underwent both ALND and PMRT, and 8 (28%) had PMRT alone or neither treatment. Overall, return to the operating room for ALND was indicated for 39 (6.2%) of the 623 patients with three or more +SLNs and for those who had one or two +SLNs without PMRT indication.
conclusionsIn this study, only 6% of the cN0 patients who had SLN frozen section omitted at upfront mastectomy exhibited an indication for cALND. Receipt of ALND+PMRT for the patients with involvement of one or two nodes was rare, occurring for just 2% of the patients. Axillary management was optimized by routine omission of frozen section for cT1-3N0 patients undergoing upfront mastectomy.
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