Table 6
Review of studies assessing the role of serial or step sectioning and immunohistochemistry in the assessment of sentinel lymph nodes
| 1st author | Number of patients | Number (%) of patients positive by standard HE | Protocols compared* | Number (%) of patients upstaged | Comments |
|---|---|---|---|---|---|
| *The standard HE serving as baseline examination comprised halving or macrosectioning SLNs at 2–3 mm and examining 1 HE section from each part, except in 2 studies,34,41 where 2 HE sections were obtained. | |||||
| HE, haematoxylin and eosin; IHC, immunohistochemistry against epithelial markers, generally cytokeratin with AE1/AE3, MNF-116, CAM 5.2, PanCK antibodies; some studies also used epithelial membrane antigen; pN1a, micrometastasis10; pN0(i+), isolated tumour cells12; SS, serial sectioning. | |||||
| Jannink35 | 19 | 6 (31.6%) | 1 HE v SS and IHC at 0.5 mm | 3 (23.1%) | 2 patients upstaged by SS and 1 by IHC |
| Kelley36 | 28 | 9 (32.1%) | 1 HE v 4 level HE and 2 level IHC | 2 (10.5%) | 1 patient upstaged by SS and 1 by IHC; distance of levels not stated |
| Czerniecki37 | 41 | 12 (29.3%) | 1 HE v 4 level IHC | 3 (10.3%) | Evaluates SS too; distance of levels not stated |
| Turner38 | 52 | 10 (19.2%) | 2 HE at 0.04 mm v 2 further levels at 0.16 mm from each other | 2 (4.8%) | |
| Turner38 | 52 | 10 (19.2%) | 2 HE at 0.04 mm v 2 IHC at 0.04 mm | 8 (19%) | |
| Turner38 | 52 | 10 (19.2%) | 2 HE at 0.04 mm v 8 further levels IHC at 0.04 mm from each other | 9 (21.4%) | Evaluates SS too |
| Noguchi39 | 62 | 24 (38.7%) | 1 HE v same level IHC | 1 (2.6%) | Retrospectively, the metastasis identified by IHC could have been seen on HE |
| Viale40 | 155 | 45 (29%) | 1 HE v 14 further levels at 0.05 mm from each other; frozen sections | 25 (22.7%) | IHC did not increase the sensitivity of SLN assessment |
| Pendas41 | 478 | 93 (19.5%) | 1 HE v same level IHC | 41 (10.6%) | |
| Kowolik42 | 33 | 8 (24.4%) | 2 HE v same level IHC | 4 (16%) | 2 pN1a, 2 pN0(i+) |
| Liu43 | 38 | 12 (31.6%) | 1 HE v 3 further HE sections and IHC | 5 (19.2%) | 2 patients upstaged by HE and 3 by IHC; distance of levels not stated |
| Nährig44 | 40 | 18 (45%) | 1 HE v 4 further HE at 0.15 mm from each other | 4 (18.2%) | 1 pN1a, 3 pN0(i+); evaluates SS too |
| Mann45 | 51 | 10 (19.6%) | 1 HE v same level IHC | 10 (24.4%) | 2 of the 3 illustrated cases identified by IHC could have been identified by HE too |
| Weaver15 | 386 | 104 (27.0%) | 1 HE v 2 further HE levels at 0.1 mm from each other and 1 level IHC at 0.1 mm | 19 (8.9%) | |
| Péley46 | 68 | 21 (30.9%) | 1 HE v SS with IHC only at 0.25 mm | 12 (25.5%) | |
| Dowlatshahi47 | 200 | 34 (17%) | 1 HE v SS with IHC only at 0.25 mm | 51 (30.7%) | 24 pN1a, 27 pN0(i+) |
| Torrenga48 | 250 | 69 (27.6%) | 1 HE v 4 further HE at 0.25 mm from each other | 7 (3.9%) | |
| Torrenga48 | 250 | 69 (27.6%) | 1 HE v same level IHC | 5 (2.8%) | |
| Torrenga48 | 250 | 69 (27.6%) | 1 HE v 4 further IHC at 0.25 mm from each other | 17 (9.4%) | Evaluates SS too |
| Wong49 | 973 | 104 (10.7%) | 1 HE v 2 level IHC | 58 (6.7%) | |
| Yared50 | 96 | 0 | 1 HE v 2 level HE and 1 level IHC at 0.005 mm from each other | 17 (17.7%) | |
| This study A | 123 | 55 (44.7%) | 1 HE v SS at 0.05–0.1 mm, IHC levels at 0.3–0.6 mm from each other | 19 (27.9%) | 1 pN1a and 3 pN0(i+) first identified by IHC |
| This study B | 123 | 29 (23.6%) | 1 HE v SS at 0.25 mm, IHC levels at 0.75 mm from each other | 18 (19.1%) | 3 pN1a and 3 pN0(i+) first identified by IHC |
