RE: [Histonet] Re: Sentinel node protocol

From:"Weems, Joyce"

If I understand this procedure correctly it was originally intended to eliminate further surgery at the time of the procedure by doing the frozen section on the sentinel node. Rapid immunos were promoted. If there was not malignancy, no further suregery would be done. Then, fear of the radioactive component became a problem and somehow it become distorted as to what is required. In my opinion, frozens do not need to be done unless it will eliminate further surgery. It is just extra cost and may compromise immunos for the permanent section. We do not do frozens. We do the cytokeratin immunos for breast and melanoma panel for melanomas. I have not tracked statistics for how many require more surgery. 

This seems to be a procedure that could use standardization, instead of the government trying to eliminate payment for biopsies that need separate diagnoses. (MUEs)  In my humble opinion....


Joyce Weems
Pathology Manager
Saint Joseph's Hospital of Atlanta

-----Original Message-----
From: [] On Behalf Of
Sent: Friday, February 02, 2007 11:39 PM
Subject: [Histonet] Re: Sentinel node protocol

Michelle Seagle at Rutherford Hospital (where?) asks: >>I was interested in knowing what other hospital labs use for their sentinel lymph node protocols for breast cases and melanoma cases. I think our hospital's is a little over kill.<<

This topic is very controversial and very little standardized. The service I just left did a great many of these, many breast cases, many with multiple sentinel nodes. They did one H & E, with S100 and MELAN-A for melanoma, and cytokeratin AE1/AE3 for breast and squamous carcinoma. Unfortunately, frozen sections were also performed, more often than not. 

My personal preference would be no frozen section (except for nodes grossly positive on gross examination, which should be done with great care), overnight fixation before processing, with the slides as above, and the histotechnologist checking them for adequacy before handing them to me.

If Michelle Seagle's question includes how to deal with the radioactivity of the specimen: ignore it.

Bob Richmond
Samurai Pathologist
Knoxville TN
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