Journal List > J Korean Breast Cancer Soc > v.7(3) > 1076725

J Korean Breast Cancer Soc. 2004 Sep;7(3):154-160. Korean.
Published online September 30, 2004.
Copyright © 2004 Korean Breast Cancer Society
Intraoperative Examination of Sentinel Lymph Nodes Using Rapid Cytokeratin Immunohistochemical Staining in Breast Cancer Patients
Il Kyun Lee, Joon Jeong, Hang Seok Chang, Byeong Woo Park, Woo Hee Jung,1 Soon Won Hong,1 Ki Keun Oh,2 Yong Hoon Ryu,3 and Hy De Lee
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
1Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
2Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
3Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea.
Received May 06, 2004; Accepted August 16, 2004.



Sentinel lymph node (SLN) biopsy has become a new standard procedure in the treatment of patients with early breast cancer. Furthermore, many institutions have begun offering the sentinel lymph node biopsy without simultaneous axillary dissection as a possible standard procedure when the SLN was free from tumors. For appropriate intraoperative decision making on the presence of cancer cells in axillary lymph nodes, a fast and accurate method to assess the SLN is required. The authors performed a prospective investigation of the relative merits of rapid cytokeratin immunohistochemical (IHC) staining of the SLN removed during the operations of breast cancer patients.


Between December 2002 and August 2003, 38 patients with T1and T2 breast cancer were enrolled after undergoing successful sentinel lymph node biopsy. A total of 60 sentinel lymph nodes (mean number, 1.58) were biopsied and first examined by hematoxylin-eosin (H&E) staining. All the tumor free sentinel lymph nodes by H&E stained section were immunostained for cytokeratin using a rapid immunohistochemical assay (Cytokeratin (PAN), 1 : 50, Newcastle, UK) during the operation. Finally, the sentinel lymph nodes were submitted for paraffin embedding and serial section after surgery. Both H&E stained and cytokeratin immunostained sections were also performed.


This technique has a turnaround time of less than 20 minutes during the operation. Rapid IHC staining revealed 4 positive sentinel lymph nodes that were negative for metastasis by H&E staining. Among these false negative 4 cases, two cases had problems with the frozen section of H&E staining and the other 2 cases had problems due to micrometastasis. This study showed a sensitivity of 88.89%, a specificity of 100%, an accuracy of 98.33%, and a negative predictive value of 98.08%. The false-negative case (1 of 52), which was negative on H&E staining and rapid IHC staining during the operation, was disclosed as positive only after a serial permanent section examination with IHC stain.


The introperative examination of sentinel lymph nodes is a highly accurate and effective way of predicting the axillary lymph node status of patients with breast cancers. This may be a promising technique in deciding whether to spare axillary lymph node dissection for the patient in the operating room.

Keywords: Breast cancer; Sentinel lymph node; Frozen section; Rapid immunohistochemistry; Cytokeratin