What Constitutes Adequate Study of Axillary Lymph Nodes in Breast Cancer

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Abstract
This study was undertaken to determine the value of the clearing technique and multilevel sectioning of [human] lymph nodes to aid in optimally examining axillary dissections for lymph node metastases. Consecutive mastectomy specimens (100) with axillary dissections were initially examined by a routine technique: examination of fat for lymph nodes by inspection and palpation and examination of 1 microsection from each lymph node. The remaining axillary tissue was then cleared using the technique of Durkin and Haagensen and each of the originally examined lymph nodes was resectioned at 2 additional deeper levels. In a routine examination, 2203 lymph nodes were found with 211 lymph nodes containing metastatic tumor. Clearing disclosed 412 additional lymph nodes, of which 17 contained metastatic tumor. The 2 additional microsections of lymph nodes revealed tumor in only 2 lymph nodes which were initially free of tumor. The extended study of the axilla did not add significantly to the routine examination.