Annals of Surgical Oncology Sign the Guestbook
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Tanis, P. J.
Right arrow Articles by Kroon, B. B. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Tanis, P. J.
Right arrow Articles by Kroon, B. B. R.
Related Collections
Right arrow Sentinel lymph node
Right arrow Sentinel lymph node
Annals of Surgical Oncology 8:222-226 (2001)
© 2001 Society of Surgical Oncology

ORIGINAL ARTICLES

Frozen Section Investigation of the Sentinel Node in Malignant Melanoma and Breast Cancer

Pieter J. Tanis, MD, Rob P. A. Boom, MD, PhD, Heimen Schraffordt Koops, MD, PhD, Ian F. Faneyte, MD, Johannes L. Peterse, MD, Omgo E. Nieweg, MD, PhD, Emiel J. T. Rutgers, MD, PhD, Anton T. M. G. Tiebosch, MD, PhD and Bin B. R. Kroon, MD, PhD

From the Departments of Surgery (PJT, OEN, EJTR, BBRK) and Pathology (IFF, JLP), the Netherlands Cancer Institute, Amsterdam, the Netherlands; the Department of Surgery (RPAB), Amstelveen Hospital, Amstelveen, the Netherlands; and the Departments of Surgery (HSK) and Pathology (ATMGT), Groningen University Hospital, Groningen, the Netherlands.

Correspondence: Address correspondence and reprint requests to: P. J. Tanis, MD, Department of Surgery, the Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Fax: 31-20-5122554; E-mail: ptanis{at}nki.nl


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Background: Intraoperative frozen section investigation allows immediate regional lymph node dissection when the sentinel node contains tumor. The purpose of this study was to determine the sensitivity of frozen section diagnosis of the sentinel node in melanoma and breast cancer patients.

Methods: A total of 177 sentinel nodes from 99 melanoma patients and 444 lymph nodes from 262 breast cancer patients were assessed by frozen section investigation. Nodes were bisected, and a complete cross-section was obtained for frozen section. Step sections at three levels were made of the remaining lymphatic tissue and were stained with hematoxylin and eosin and S100/HMB45 (melanoma) or CAM5.2 (breast cancer) to obtain a final pathological diagnosis.

Results: Frozen section investigation revealed metastases in 8 of 17 node-positive melanoma patients (47%). Seventy-one of 96 breast cancer patients (74%) with lymph node metastases were identified with frozen section. The specificity was 100% and 99%, respectively.

Conclusion: The sensitivity of intraoperative frozen section investigation of sentinel nodes was 47% in melanoma patients and 74% in breast cancer patients. Frozen section examination allows immediate axillary lymph node dissection in the majority of node-positive breast cancer patients. Frozen section analysis is not recommended in patients with melanoma.

Key Words: Frozen section • Sentinel node • Breast cancer • Melanoma


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
PATIENTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
The concept of orderly progression of solid tumors through the lymphatic system implies that the decision to perform regional node dissection can be based on the tumor status of the sentinel lymph node.1 Two techniques can be applied to assess this tumor status intraoperatively: touch imprint cytology (contact cytology) and frozen section analysis. In this article, we describe our results of frozen section investigation of sentinel lymph nodes in melanoma and breast cancer patients and review the literature on this technique.


   PATIENTS AND METHODS
TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
Between December 1993 and March 1995, 99 consecutive patients with clinically localized cutaneous melanoma underwent a sentinel node procedure with intraoperative frozen section investigation. Forty-five patients underwent the procedure at The Netherlands Cancer Institute and 54 at the Groningen University Hospital following the same protocol. The primary melanoma was located in the head and neck region in 9 patients, on the trunk in 25, on the upper limb in 18, and on the lower limb in 47. The Breslow thickness was between 1.1 and 11.0 mm with a mean of 2.9 mm and a median thickness of 2.2 mm. Ulceration was present in 33 patients (33%).

A total of 262 consecutive T1–2N0 breast carcinoma patients underwent 265 sentinel node procedures with intraoperative frozen section investigation between January 1999 and June 2000 (three bilateral): 230 operations were performed at the Netherlands Cancer Institute and 35 at the Amstelveen Hospital. The mean size of the tumors was 1.9 cm (range, 0.2–8.0 cm) with a pathological stage T1 in 178 patients (67%), T2 in 86 (32%), and T3 in 1. The histology of the tumor was invasive ductal carcinoma in 214 tumors (81%), invasive lobular carcinoma in 34 (13%), and various other types in the remaining 17 (6%). Specimens from the two hospitals were assessed in the same pathology laboratory.

One day before operation, lymphoscintigraphy was performed after injection of 99mTc-labeled nanocolloid (Nanocoll, Amersham Cygne, Eindhoven, The Netherlands).

Surgery was performed guided by patent blue dye (Laboratoire Guerbet, Aulnay-Sous-Bois, France) and a hand-held gamma ray detection probe (Neoprobe, Johnson & Johnson, Hamburg, Germany, and Europrobe, Joure, the Netherlands). The technique has been described in detail elsewhere.2–4

The excised lymph nodes were submitted fresh for frozen section investigation. While we awaited the result, wide local excision of the tumor site or mastectomy was performed. Immediate regional node dissection was performed when frozen section analysis revealed metastatic disease in the sentinel node. Some breast cancer patients received radiotherapy of the axilla when the sentinel node was tumor-positive, depending on tumor stage and menopausal status.

All lymph nodes were bisected, and one level frozen section of both cut surfaces was made. Care was taken to obtain complete cross-sections of the maximum diameter, preferably including the hilum and marginal sinus. Each frozen section slide was stained with hematoxylin and eosin (H&E). The remaining tissue was formalin fixated, paraffin embedded, and cut at three levels 50–100 µm apart. All these sections were evaluated with H&E staining. The first level was also examined with immunohistochemical staining. The anticytokeratin reagent CAM5.2 (Becton Dickinson, San Jose, CA) was used at a dilution of 1:250 in sentinel nodes of breast cancer patients.5 Both S-100 (Dako, Glostrup, Denmark) at a dilution of 1:40.000 and HMB45 (Dako) at a dilution of 1:200 were used in melanoma patients.6 Fisher’s exact test was used to compare the false-negative rates between subgroups with different tumor stages.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
DISCUSSION
 REFERENCES
 
In the 99 melanoma patients, 177 sentinel nodes were excised (mean, 1.8 per patient; range, 1–4). Frozen section investigation revealed metastatic involvement of the sentinel node in eight patients. In another nine patients, metastases were found only in step sections (eight patients) or after immunohistochemical staining (one patient). The sensitivity of frozen section investigation was 47% and the specificity 100%. The negative predictive value was 90% (82 of 91). The sentinel node was the only positive node in 13 of 17 patients (76%). The relation between the Breslow thickness and the sensitivity of the frozen section examination is displayed in Table 1.


View this table:
[in this window]
[in a new window]
  		TABLE 1. Relation between Breslow thickness and sensitivity of the frozen section investigation of the sentinel node in melanoma patients
 
In breast cancer patients, lymph node metastases were found by frozen section investigation in 71 of 265 procedures (27%). Twenty-five procedures were false-negative (sensitivity 74%). In 10 patients, the tumor-positive lymph node was not sent for frozen section investigation because of its small size or localization in the internal mammary chain or in the breast parenchyma. One frozen section result was false-positive (specificity 99%), because no tumor cells were seen after serial sectioning and immunohistochemical staining. The negative predictive value was 87% (169 of 194). In the 265 sentinel node procedures in breast cancer patients, 444 lymph nodes (406 sentinel nodes, 38 second-tier nodes) were evaluated with H&E frozen sections (mean, 1.7; range, 1–6). Definitive evaluation showed tumor cells in 122 of 444 assessed lymph nodes (27%), which corresponded with a sensitivity of 73% (89 of 122) per node. Twenty-nine of 33 lymph nodes that were negative in the frozen sections contained metastases smaller than 2 mm. Eighteen of these 29 micrometastases were found only by immunohistochemical staining with CAM5.2.

Six of 24 lymph node metastases of a lobular carcinoma (25%) were not detected by frozen section investigation and 26 of 95 lymph node metastases (27%) in ductal carcinoma. The false-negative rates of the frozen sections for tumor stage T1a,b, T1c, and T2 or greater were 40% (2 of 5), 25% (13 of 51), and 25% (10 of 40), respectively (Table 2).


View this table:
[in this window]
[in a new window]
  		TABLE 2. Relation between tumor stage and the sensitivity of intraoperative frozen section investigation of the sentinel node in breast cancer
 
Review of the frozen sections showed tumor cells in the marginal sinus originally interpreted as histiocytes in one patient. The sentinel node was the only positive node in 53 of 82 cases (65%) with complete axillary lymph node dissection.


   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
 DISCUSSION
REFERENCES
 
Intraoperative pathological assessment of the sentinel node allows for a regional lymph node dissection during the same session. Sensitivity and specificity are important factors in deciding whether a technique should be used. When the sensitivity is too low, the efforts and costs will exceed the benefits and an unreliable method unduly distresses the patients. The specificity of frozen section analysis is 100% in almost all studies (Tables 3 and 4) and, therefore, overtreatment rarely will occur.


View this table:
[in this window]
[in a new window]
  		TABLE 3. Results of intraoperative pathological investigation of the lymph nodes in melanoma patients in the literature
 

View this table:
[in this window]
[in a new window]
  		TABLE 4. Results of intraoperative pathological investigation of the lymph nodes in breast cancer patients in the literature
 
This study reveals a low sensitivity (47%) of frozen section analysis in melanoma patients and is in agreement with two other studies (Table 3).7,8 Reliability of frozen section analysis in breast cancer patients seems to be more favorable. The sensitivity of frozen section at one level in this study was 74%. Three other studies, which also included more than 75 patients with lymph node metastases, showed similar sensitivities of 68%, 77%, and 87% (Table 4).9–11 However, a study with 890 patients revealed a much lower sensitivity of 58%.12

Several factors can influence the reliability of intraoperative pathological examination of lymph nodes. The first is the tumor load of the sentinel node. In melanoma patients and patients with lobular breast cancer, often small foci or single metastatic cells are found, detectable only with step sections or immunohistochemistry.7,13 However, the percentage of false-negative frozen sections in lobular carcinoma compared with ductal carcinoma was not different in this study, 25% and 27%, respectively. The second factor is the size of the lymph node. It may be impossible to capture one entire cross-section of a large lymph node in one frozen section. The third factor is the number of assessed levels per node. We made a single frozen section of each lymph node in both malignancies, which resulted in a relatively small chance of encountering the metastasis (sampling error). Gibbs et al.7 improved the sensitivity by adding a second frozen section level. In breast cancer patients, Viale et al.14 made 15 pairs of frozen sections with H&E and rapid cytokeratin staining of each of two halves (60 sections). They found 64% of the sentinel lymph node metastases in the first pair of sections, but they did observe metastases as far as the 15th cutting level. A disadvantage of these large numbers of frozen sections is that no tissue remains for more sensitive pathological examination. Also, this approach is time-consuming and requires additional personnel. Some authors have suggested that the sensitivity of frozen section analysis is lower in small tumors.12 An explanation for this phenomenon might be the smaller sampling error in large tumors, because of the relatively higher incidence of macrometastases compared with smaller tumors. A difference between the sensitivity of frozen section investigation in melanomas with a Breslow thickness of more than 4.0 mm and from 1.5 to 4.0 mm was seen in this study (Table 1), but this difference was not significant (P = .5). The difference between the sensitivity of frozen section examination in T1a,b and T1c breast cancer (Table 2) also was not significant (P = .4). Finally, the quality of the frozen section and the experience of the pathologist are important factors.

The calculated sensitivity of an intraoperatively used method depends on the type and the quality of the definitive pathological examination (gold standard). The use of H&E-stained step sections in breast cancer was reviewed by van Diest et al.,15 who found that 9% of initially negative lymph nodes were converted to tumor-positive with this approach. The increase in sensitivity by immunohistochemical staining in melanoma was 45% in one study.16 Three studies addressed the additional value of immunohistochemical staining in breast cancer and found 14%, 31%, and 36% of all positive sentinel nodes only with this technique.17–19 These metastases would have been missed with frozen section examination. This results in substantial overestimation of the frozen section sensitivity in studies without immunohistochemistry as the gold standard. Molecular analysis with the reverse-transcriptase polymerase chain reaction may increase the number of ultimately detected (micro)metastases even further, although this remains to be established.15

Explanations for the difference in sensitivity of frozen section examination in melanoma and breast cancer may include the higher incidence of micrometastases with a single tumor cell distribution in melanoma and the more difficult recognition of that disease.

The a priori chance of detecting a lymph node metastasis of melanoma is approximately 20%.1,20,21 The sensitivity of approximately 50% means that occult metastases are identified with frozen section microscopy in only 10% of melanoma patients. In the other 90% of cases, operation time is reserved for a regional lymph node dissection that is not performed. Even in thick melanomas (> 4.0 mm), reservation of operation time for a standard lymphadenectomy will be needless in 85% of the patients. Therefore, we have abandoned frozen section analysis in this disease.

In breast cancer, the higher a priori chance of lymph node metastases (40%) together with the higher sensitivity of frozen section examination (75%) results in unused operation time in 70% of cases.22,23 Thirty percent of the patients are spared a second admission and operation. This is acceptable in our setting, and we continue to perform frozen section investigation of sentinel nodes in breast cancer patients. A disadvantage of this approach is that patients experience great distress when the frozen section is false-negative, despite the fact that this risk has, of course, been discussed ahead of time. An alternative approach would be to exclude stage T1a,b breast cancer patients because of the low incidence of lymph node metastases and a possibly lower sensitivity of intraoperative frozen section analysis in this subgroup (Table 2).

In our series, the only false-positive frozen section of a sentinel node in breast cancer was encountered. We actually performed an unnecessary axillary lymph node dissection in this patient, but fortunately there was another indication for axillary clearance because of the multicentricity of the tumor. The risk of a false-positive frozen section report can be limited by awaiting the definitive pathological examination in case of doubt.

In conclusion, this study shows a lower sensitivity of a single H&E-stained frozen section of the sentinel lymph node in melanoma (47%) as compared with breast cancer (74%). Frozen section examination allows immediate axillary lymph node dissection in the majority of node-positive breast cancer patients. We do not recommend frozen section examination in melanoma.


   Footnotes
 
Presented, in part, at the 4th World Conference on Melanoma, Sydney, Australia, June 10–14, 1997, and the 10th Congress of the European Society of Surgical Oncology, Groningen, the Netherlands, April 5–8, 2000.

Received for publication April 14, 2000. Accepted for publication October 26, 2000.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 

  1. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127: 392–9.[Abstract]
  2. Nieweg OE, Jansen L, Kroon BBR. Technique of lymphatic mapping and sentinel node biopsy for melanoma. Eur J Surg Oncol 1998; 24: 520–4.[CrossRef][Medline]
  3. Rutgers EJT, Jansen L, Nieweg OE, De Vries J, Schraffordt Koops H, Kroon BBR. Technique of sentinel node biopsy in breast cancer. Eur J Surg Oncol 1998; 24: 316–9.[CrossRef][Medline]
  4. Pijpers R, Meijer S, Hoekstra OS, et al. Impact of lymphoscintigraphy on sentinel node identification with technetium-99m-colloidal albumin in breast cancer. J Nucl Med 1997; 38: 366–8.[Abstract/Free Full Text]
  5. Leader M, Patel J, Makin, Henry K. An analysis of the sensitivity and specificity of the cytokeratin marker CAM 5.2 for epithelial tumors: Results of a study of 203 sarcomas, 50 carcinomas, and 28 malignant melanomas. Histopathol 1986; 10: 1315–24.[Medline]
  6. Ordonez NG, Ji XL, Hickey RC. Comparison of HMB45 monoclonal antibody and S-100 protein in the immunohistochemical diagnosis of melanoma. Am J Clin Pathol 1988; 90: 385–90.[Medline]
  7. Gibbs JF, Huang PP, Zhang PJ, Kraybill WG, Cheney R. Accuracy of pathologic techniques for the diagnosis of metastatic melanoma in sentinel lymph nodes. Ann Surg Oncol 1999; 6: 699–704.[Abstract]
  8. Clary BM, Lewis JJ, Brady MS, Busam K, Coit DG. Should frozen section analysis of the sentinel node be performed in patients with melanoma?. Eur J Nucl Med 1999; 26: S68.
  9. Zurrida S, Galimberti V, Orvieto E, et al. Radioguided sentinel node biopsy to avoid axillary dissection in breast cancer. Ann Surg Oncol 2000; 7: 28–31.[Abstract]
  10. Noguchi M, Minami M, Earashi M, et al. Intraoperative assessment of axillary lymph node metastases in operable breast cancer. Breast Cancer Res Treat 1996; 40: 179–85.[CrossRef][Medline]
  11. Hill AD, Tran KN, Akhurst T, et al. Lessons learned from 500 cases of lymphatic mapping for breast cancer. Ann Surg 1999; 229: 528–35.[CrossRef][Medline]
  12. Weiser MR, Montgomery LL, Susnik B, Borgen PI, Cody HS III. Is routine intraoperative frozen section of sentinel lymph nodes in breast cancer patients worthwhile? In: Abstract Book from the 53rd Annual Meeting of the Society of Surgical Oncology, March 16–19, 2000, Arlington Heights, IL, Society of Surgical Oncology, 2000:23.
  13. McGuckin MA, Cummings MC, Walsh MD, Hohn BG, Bennett IC, Wright RG. Occult axillary node metastases in breast cancer: Their detection and prognostic significance. Br J Cancer 1996; 73: 88–95.[Medline]
  14. Viale G, Bosari S, Mazzarol G, et al. Intraoperative examination of axillary sentinel lymph nodes in breast carcinoma patients. Cancer 1999; 85: 2433–8.[CrossRef][Medline]
  15. Van Diest PJ, Peterse HL, Borgstein PJ, Hoekstra OS, Meijer CJ. Pathological investigation of sentinel lymph nodes. Eur J Nucl Med 1999; 26: S43–9.[CrossRef][Medline]
  16. Messina JL, Glass LF, Cruse CW, Berman CG, Ku NK, Reintgen DS. Pathologic examination of the sentinel lymph node in malignant melanoma. Am J Surg Pathol 1999; 23: 686–90.[CrossRef][Medline]
  17. McIntosh SA, Going JJ, Soukop M, Purushotham AD, Cooke TG. Therapeutic implications of the sentinel lymph node in breast cancer. Lancet 1999; 354: 570.[CrossRef][Medline]
  18. Pendas S, Dauway E, Cox CE, et al. Sentinel node biopsy and cytokeratin staining for the accurate staging of 478 breast cancer patients. Am Surg 1999; 65: 500–5.[Medline]
  19. Schreiber RH, Pendas S, Ku NN, et al. Microstaging of breast cancer patients using cytokeratin staining of the sentinel lymph node. Ann Surg Oncol 1999; 6: 95–101.[Abstract]
  20. Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: The prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol 1999; 17: 976–83.[Abstract/Free Full Text]
  21. Jansen L, Nieweg OE, Peterse JL, Hoefnagel CA, Valdés Olmos RA, Kroon BBR. Reliability of sentinel lymph node biopsy for staging melanoma. Br J Surg 2000; 87: 484–9.[CrossRef][Medline]
  22. Giuliano AE, Jones RC, Brennan MB, Statman RC. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997; 15: 2345–50.[Abstract/Free Full Text]
  23. Doting MHE, Jansen L, Nieweg OE, et al. Lymphatic mapping with intra-lesional tracer administration in breast cancer patients. Cancer 2000; 88: 2546–52.[CrossRef][Medline]
  24. Fisher CJ, Boyle S, Burke M, Price AB. Intraoperative assessment of nodal status in the selection of patients with breast cancer for axillary clearance. Br J Surg 1993; 80: 457–8.[Medline]
  25. Flett MM, Going JJ, Stanton PD, Cooke TG. Sentinel node localization in patients with breast cancer. Br J Surg 1998; 85: 991–3.[CrossRef][Medline]
  26. Turner RR, Giuliano AE. Intraoperative pathologic examination of the sentinel lymph node. Ann Surg Oncol 1998; 5: 670–2.[CrossRef][Medline]
  27. Mayzler O, Goldstein J, Koretz J. Is frozen section examination (FSE) of the sentinel lymph node (SLN) a reliable predictor of histologic status? Eur J Nucl Med 1999; 26: S56.
  28. Dixon JM, Mamman U, Thomas JM. Accuracy of intraoperative frozen-section analysis of axillary nodes. Br J Surg 1999; 86: 392–5.[CrossRef][Medline]
  29. Kelley SW, Komorowski RA, Dayer AM. Axillary sentinel lymph node examination in breast carcinoma. Arch Pathol Lab Med 1999; 123: 533–5.[Medline]
  30. Van Diest PJ, Torrenga H, Borgstein PJ, et al. Reliability of intraoperative frozen section and imprint cytological investigation of sentinel lymph nodes in breast cancer. Histopathology 1999; 35: 14–8.[CrossRef][Medline]



This article has been cited by other articles:


Home page
 Ann. Surg. Oncol.Home page
K. Y. Bilimoria, C. M. Balch, D. J. Bentrem, M. S. Talamonti, C. Y. Ko, J. R. Lange, D. P. Winchester, and J. D. Wayne
Complete Lymph Node Dissection for Sentinel Node-Positive Melanoma: Assessment of Practice Patterns in the United States
Ann. Surg. Oncol., June 1, 2008; 15(6): 1566 - 1576.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
K. Shimazu, Y. Tamaki, T. Taguchi, F. Tsukamoto, T. Kasugai, and S. Noguchi
Intraoperative Frozen Section Analysis of Sentinel Lymph Node in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy
Ann. Surg. Oncol., June 1, 2008; 15(6): 1717 - 1722.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Cancer Res.Home page
M. Tsujimoto, K. Nakabayashi, K. Yoshidome, T. Kaneko, T. Iwase, F. Akiyama, Y. Kato, H. Tsuda, S. Ueda, K. Sato, et al.
One-step Nucleic Acid Amplification for Intraoperative Detection of Lymph Node Metastasis in Breast Cancer Patients
Clin. Cancer Res., August 15, 2007; 13(16): 4807 - 4816.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
S. Gretschel, A. Bembenek, M. Hunerbein, S. Dresel, W. Schneider, and P. M. Schlag
Efficacy of Different Technical Procedures for Sentinel Lymph Node Biopsy in Gastric Cancer Staging
Ann. Surg. Oncol., July 1, 2007; 14(7): 2028 - 2035.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
V. Soo, P. Shen, R. Pichardo, H. Azzazy, J. H. Stewart, K. R. Geisinger, and E. A. Levine
Intraoperative Evaluation of Sentinel Lymph Nodes for Metastatic Melanoma by Imprint Cytology
Ann. Surg. Oncol., May 1, 2007; 14(5): 1612 - 1617.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
S. Raja, J. Ching, L. Xi, S. J. Hughes, R. Chang, W. Wong, W. McMillan, W. E. Gooding, K. S. McCarty Jr, M. Chestney, et al.
Technology for Automated, Rapid, and Quantitative PCR or Reverse Transcription-PCR Clinical Testing
Clin. Chem., May 1, 2005; 51(5): 882 - 890.
[Abstract] [Full Text] [PDF]

Home page
 Cancer Res.Home page
R. L. Ferris, L. Xi, S. Raja, J. L. Hunt, J. Wang, W. E. Gooding, L. Kelly, J. Ching, J. D. Luketich, and T. E. Godfrey
Molecular Staging of Cervical Lymph Nodes in Squamous Cell Carcinoma of the Head and Neck
Cancer Res., March 15, 2005; 65(6): 2147 - 2156.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
E. Brogi, E. Torres-Matundan, L. K. Tan, and H. S. Cody III
The Results of Frozen Section, Touch Preparation, and Cytological Smear Are Comparable for Intraoperative Examination of Sentinel Lymph Nodes: A Study in 133 Breast Cancer Patients
Ann. Surg. Oncol., February 1, 2005; 12(2): 173 - 180.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
L. Fortunato, M. Amini, M. Farina, S. Rapacchietta, L. Costarelli, F. R. Piro, G. Alessi, P. Pompili, S. Bianca, and C. E. Vitelli
Intraoperative Examination of Sentinel Nodes in Breast Cancer: Is the Glass Half Full or Half Empty?
Ann. Surg. Oncol., November 1, 2004; 11(11): 1005 - 1010.
[Abstract] [Full Text] [PDF]

Home page
 Cancer Res.Home page
S. Sellappan, R. Grijalva, X. Zhou, W. Yang, M. B. Eli, G. B. Mills, and D. Yu
Lineage Infidelity of MDA-MB-435 Cells: Expression of Melanocyte Proteins in a Breast Cancer Cell Line
Cancer Res., May 15, 2004; 64(10): 3479 - 3485.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
T. M. Pawlik, M. I. Ross, and J. E. Gershenwald
Lymphatic Mapping in the Molecular Era
Ann. Surg. Oncol., April 1, 2004; 11(4): 362 - 374.
[Full Text] [PDF]

Home page
 Jpn J Clin OncolHome page
N. Wada, S. Imoto, T. Hasebe, A. Ochiai, S. Ebihara, and N. Moriyama
Evaluation of Intraoperative Frozen Section Diagnosis of Sentinel Lymph Nodes in Breast Cancer
Jpn. J. Clin. Oncol., March 1, 2004; 34(3): 113 - 117.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
H. Torrenga, S. Meijer, H. Fabry, and J. van der Sijp
Sentinel Node Biopsy in Breast Cancer Patients: Triple Technique as a Routine Procedure
Ann. Surg. Oncol., March 1, 2004; 11(3_suppl): 231S - 235S.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
D. Lardinois, T. Brack, A. Gaspert, T. Spahr, D. Schneiter, H.C. Steinert, and W. Weder
Bronchoscopic radioisotope injection for sentinel lymph-node mapping in potentially resectable non-small-cell lung cancer
Eur. J. Cardiothorac. Surg., May 1, 2003; 23(5): 824 - 827.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
D. R. McCready
Intraoperative Sentinel Node Assessment Is a Touchy Subject
Ann. Surg. Oncol., May 1, 2002; 9(4): 321 - 323.
[Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Tanis, P. J.
Right arrow Articles by Kroon, B. B. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Tanis, P. J.
Right arrow Articles by Kroon, B. B. R.
Related Collections
Right arrow Sentinel lymph node
Right arrow Sentinel lymph node

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS