Sentinel lymph nodes

Question: I had surgery two weeks ago for an invasive ductal cancer and my surgeon told me that during the operation my sentinel lymph nodes (3 in total) were sent to pathology for frozen section which he said is a “quick read” and were negative. However, my report now says two of the nodes are positive. He told me this was a possibility but I don’t understand–did the pathologist miss this during my operation? Now my surgeon tells me I need to go back for a lymph node dissection.

Answer: Your situation is not uncommon. Unfortunately this is one of the limitations of “frozen section.” What this term means is during an operation, a surgeon will send a piece of tissue that he/she is concerned about to the pathologist. The pathologist then quick freezes the tissue and makes a slide to look at under the microscope. This is just a sample and with sentinel lymph nodes sometimes only part of the lymph node is frozen. The remainder is sent off for “permanents” which means they are processed like other tissue, stained, and then sent to the pathologist for a formal evaluation. This usually takes another day or two. So it is not uncommon at all to find small areas of cancer in the sentinel lymph nodes on formal “permanent” evaluation that did not appear on the frozen section slides. I hope this information helps.

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