How Do Pathologists in Academic Institutions Across the United States and Canada Evaluate Sentinel Lymph Nodes in Breast Cancer?

A Practice Survey

Jaya Ruth Asirvatham, MBBS; Julie M. Jorns, MD


Am J Clin Pathol. 2021;156(6):980-988. 

In This Article

Materials and Methods

A 14-question multiple-choice type survey was sent to 33 US and 11 Canadian breast pathologists at 44 academic institutions between August and September 2019. Five questions related to intraoperative evaluation (IOE) of SLNs and 9 questions related to evaluation of permanent sections. The questions were as follows:

  1. Is IOE of SLN for breast cancer performed at your institution?

  2. If yes, how do you perform IOE?

  3. If you perform cytologic examination, what method do you use?

  4. If you perform frozen section (FS), is fat trimmed?

  5. If you perform FS, how is the node processed?

  6. From permanent section (PS), do you obtain single or multiple levels?

  7. If multiple, how many are cut?

  8. If multiple, how many are stained with H&E?

  9. At what interval do perform serial sectioning (in microns)?

  10. Do you obtain cytokeratin stains?

  11. Which cytokeratin stains do you prefer?

  12. For nonsentinel axillary lymph nodes that are grossly negative, how do process for PS?

  13. How would you interpret tumor cells in the pericapsular lymphatic spaces?

  14. Do you document the extent of extranodal extension in your report?