What is included in the pathologic evaluation of axillary lymph nodes in breast cancer?

Updated: Mar 20, 2019
  • Author: Oudai Hassan, MD; Chief Editor: Chandandeep Nagi, MD  more...
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Although no consensus on how to process lymph nodes to maximize the detection of isolated tumor cells (ITCs) and micrometastases exists, pathologic evaluation of axillary lymph nodes should identify all macrometastases (>2 mm). This requires submitting grossly negative lymph nodes entirely sectioned at 2-mm intervals and examining at least one hematoxylin and eosin (H&E)–stained section of each block.

Because the number of positive axillary lymph nodes is taken into consideration for pN staging of breast carcinoma, counting the number of positive lymph nodes is necessary. Therefore, each separate lymph node must be identified in a separate cassette or by inking. A representative section of each grossly positive lymph node is sufficient. Cytokeratin immunostains and estrogen-receptor (ER) immunostains (for ER-positive tumors) can be helpful to confirm the presence of tumor cell deposits, especially for lobular carcinomas or carcinomas with a histiocytoid appearance. The presence of extracapsular extension should be mentioned in the pathology report, as this has both local and systemic recurrence implications.

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