Reconsidering the Need for Intraoperative Frozen Section in Sentinel Lymph Node Biopsy for Early Breast Cancer in Bahrain

Abstract

Objectives: Frozen section is performed in sentinel lymph node biopsy (SLNB) for early breast cancer to prevent a second surgery, but it has certain disadvantages. Several trials have demonstrated the oncological safety of avoiding axillary dissection in patients with 1–2 positive nodes. This study aimed to assess the need for frozen section during SLNB in early breast cancer. Methods: This retrospective study included patients with early-stage clinically node-negative breast cancer who underwent SLNB with frozen section at Salmaniya Medical Complex, Manama, Bahrain, between October 2021 and September 2023. Patients who had neoadjuvant chemotherapy, cT3-4 tumours, ductal carcinoma in situ, occult breast cancer and previous breast cancer were excluded. Results: A total of 147 patients underwent breast cancer surgery with SLNB using frozen section. The sensitivity of frozen section was 84.6%, and the false-negative rate was 15.4%. Furthermore, 4.8% underwent immediate axillary dissection. In the remaining cases, there were only 1–2 positive sentinel nodes, and axillary dissection was omitted. Multifocal or multicentric disease was significantly associated with <3 positive sentinel nodes (71.4% versus 15.0%; P = 0.005). Patients with an indication for axillary dissection were also more likely to have tumours with lymphovascular invasion compared to patients with ≥3 positive sentinel nodes (85.7% versus 17.1%; P = 0.001). Conclusion: There was no indication for frozen section is needed in most patients with early breast cancer. Routine frozen section is unnecessary during SLNB, and permanent section alone may be sufficient without compromising overall standard of care.