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Discrepancies in current practice of pathological evaluation of sentinel lymph nodes in breast cancer. Results of a questionnaire based survey by the European Working Group for Breast Screening Pathology

¹ Department of Pathology, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
² Instituto de Patologia et Imunologia Molecular da Universidade do Porto e Serviço de Anatomia Patologica, Hospital S Joaõ, 4200 Porto, Portugal
³ Department of Pathology, Saint Savas Hospital, 115 22 Athens, Greece
⁴ Service d’Anatomie Pathologique, Hopital de Hautepierre, F-67098 Strasbourg, France
⁵ Department of Human Pathology and Oncology, University of 50134 Florence, Italy
⁶ Gerhard-Domagk Institut fur Pathologie, Universitat von Munster, D-48129 Munster, Germany
⁷ Centre Médicale Universitaire, 1211 Genève, Switzerland
⁸ Department of Pathology, Clinical Sciences Institute, University College Hospital, Galway, Ireland
⁹ Department of Pathology, The Breast Unit, HELIOS Medical Centre, D-13125 Berlin, Germany
¹⁰ Pathology Department, Mater Hospital, University College Dublin 7, Ireland
¹¹ Pathologische Ontleedkunde, University Hospital, 3000 Leuven, Belgium
¹² Department of Histopathology, City Hospital, Nottingham NG5 1PB, United Kingdom
¹³ Sezione Anatomia Patologica M. Malpighi, Universita di Bologna, Ospedale Bellaria, 40139 Bologna, Italy
¹⁴ CMP Laboratory, 1070 Bruxelles, Belgium
¹⁵ Haartman Institute, University of Helsinki, FIN 00014 Helsinki, Finland
¹⁶ National Expert & Training Centre for Breast Cancer Screening, Academisch Ziekenhuis Nijmegen, 6500 HB Nijmegen, The Netherlands
¹⁷ Department of Pathology, Rambam Hospital, 31096 Haifa, Israel
¹⁸ 2nd Department of Pathology, Semmelweis University, H-1091 Budapest, Hungary
¹⁹ Institut Paoli Calmettes, 13273 Marseille, France
²⁰ Laboratorio De Histopatologica, Centro Regional De Oncologia De Coimbra, 3000 Coimbra, Portugal
²¹ Department of Pathology, Hospital de Navarra, 31008 Pamplona, Spain
²² Department of Pathology, Hospital Virgen del Camino, 31008 Pamplona, Spain
²³ Department of Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
²⁴ Center of Laboratory Medicine and Pathology, Department of Pathology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
²⁵ Institut fur Pathologie der Karl-Franzens Universitat Graz, A-8036 Graz, Austria
²⁶ Institute of Pathology, Donauspital, A-1220 Wien, Austria
²⁷ Department of Biological Science and Human Oncology, University of Turin, 10126 Turin, Italy
²⁸ Institut Curie, Section Medicale et Hospitaliere, 75231 Paris, France
²⁹ Division d’Anatomie Pathologique, Laboratoire National de Santé, 1011 Luxembourg
³⁰ Department of Pathology and Cytology, Kalmar Hospital, S-391 85 Kalmar, Sweden
³¹ Department of Informatics, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
³² Department of Histopathology, St Bartholomew’s Hospital Medical School, London EC1A 7BE, UK

Correspondence to:
Dr G Cserni
Bács-Kiskun County Teaching Hospital; Nyíri út 38, H-6000 Kecskemét, Hungary; cserni{at}freemail.hu Aims: To evaluate aspects of the current practice of sentinel lymph node (SLN) pathology in breast cancer via a questionnaire based survey, to recognise major issues that the European guidelines for mammography screening should address in the next revision.

Methods: A questionnaire was circulated by mail or electronically by the authors in their respective countries. Replies from pathology units dealing with SLN specimens were evaluated further.

Results: Of the 382 respondents, 240 European pathology units were dealing with SLN specimens. Sixty per cent of these units carried out intraoperative assessment, most commonly consisting of frozen sections. Most units slice larger SLNs into pieces and only 12% assess these slices on a single haematoxylin and eosin (HE) stained slide. Seventy one per cent of the units routinely use immunohistochemistry in all cases negative by HE. The terms micrometastasis, submicrometastasis, and isolated tumour cells (ITCs) are used in 93%, 22%, and 71% of units, respectively, but have a rather heterogeneous interpretation. Molecular SLN staging was reported by only 10 units (4%). Most institutions have their own guidelines for SLN processing, but some countries also have well recognised national guidelines.

Conclusions: Pathological examination of SLNs throughout Europe varies considerably and is not standardised. The European guidelines should focus on standardising examination. They should recommend techniques that identify metastases > 2 mm as a minimum standard. Uniform reporting of additional findings may also be important, because micrometastases and ITCs may in the future be shown to have clinical relevance.

Abbreviations: CK, cytokeratin; EIO, European Institute of Oncology; EWGBSP, European working group for breast screening pathology; HE, haematoxylin and eosin; IHC, immunohistochemistry; ITC, isolated tumour cell; RT-PCR, reverse transcriptase polymerase chain reaction; SLN, sentinel lymph node; SLNB, sentinel lymph node biopsy

Keywords: breast cancer; guidelines; questionnaire; sentinel lymph nodes

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