A review of the accuracy of sentinel lymph node biopsy by comparing frozen section with final paraffin block H&E staining, and correlation with the final axillary lymph node dissection results

OBJECTIVES: 1) To determine the accuracy rate of sentinel lymph node? biopsy? (SLNB)? by? comparing? frozen? section? (FS)? with permanent formalin processed specimen by hematoxylin and eosin (H&E) staining; 2) To correlate with axillary lymph node dissection (ALND) histopathology results for those with positive SLNB.METHODS: This? was? a? retrospective? study? on? all? breast? cancer patients? who? underwent? SLNB? using? methylene? blue? dye.? The number of SLN harvested, number of lymph nodes confirmed on frozen section, frozen section result, number of SLN confirmed on paraffin block H&E, result of H&E. If frozen section of SLN was positive for metastasis, further data on the axillary lymph nodes harvested and its final H&E result were noted. The accuracy rate was determined.? Whenever a discordance of FS and H&E findings occurred, the interpreting pathologists were interviewed for the cause.RESULTS: A total of 34 SLNB procedures were performed. There were 24 SLNBs that turned out negative on frozen section while 10 were positive for metastasis and underwent further ALND. Three of the 24 negative SLNBs turned out to be positive (false negative rate of 12.5%). Out of the 10 positive SLNBs, 1 turned out to be negative (false positive rate of 10%). Only 6 of the 10 patients with (+) SLNB had? more? positive? nodes? harvested? upon? further? ALND.The accuracy rate of SLNB on frozen section was 88%, with sensitivity and? specificity? of? 90%? and? 87.5%? respectively.? There? were? 5 pathologists involved in the interpretations of the SLNB, and in 76% the? pathologist? interpreting? the? FS? was? different? from? the? one interpreting? the? permanent? specimen? H&E.? The? reasons? for discordance between frozen section and final H&E reading were inter-reader variability and tissue sampling limitation during frozen section.CONCLUSION:?The accuracy of frozen section in SLNB procedure is 88%.

Incorporating breast cancer screening program in the medical curriculum of Cebu Institute of Medicine

The objective of the study was to describe the incorporation of breast cancer screening program in the medical curriculum of a medical school and determine its feasibility in finding breast cancer.METHODS: From school year 2011 - 2012, a 3-hour module that assesses third year medical students' proficiency in clinical breast examination (CBE) was incorporated into the pre-clinical clerkship program at the Cebu Institute of Medicine. The students who have satisfactorily completed the module were invited to participate in the Breast Cancer Control Outreach Program (BCAcop). Pertinent data included: number of participating consultants and students,number of patients seen as well as their demographic and clinical profile, breast cancer cases found.RESULTS: Four BCAcop were conducted and 6 consultants supervised the medical students in the CBE modules and BCAcop. Seventy seven medical students passed the CBE module and participated in BCAcop. A total of 254 patients with age range of 8 to 80 (mean32 years) attended the lay forum while 246 patients (96.9%) consulted at the on-site breast clinic. Among those examined, 146 patients (59.3%) had essentially normal breasts. Fibrocystic change was the most frequent diagnosis with 49 patients (19.9%), followed by fibroadenoma with 34 patients (13.8%). Six patients (2.4%) were suspected to have breast cancer. Four patients (66.7%) proceeded to have a biopsy and were confirmed. Two patients availed of treatment.CONCLUSION: Incorporating breast cancer screening program in the medical school curriculum encourages medical students to participate in breast cancer control outreaches where their basic knowledge and skills on clinical breast exam are reinforced with actual patient contact. Furthermore, women with breast cancer are found and offered treatment through this program.