In patients with positive sentinel lymph nodes, an axillary dissection will often be performed to remove axillary disease and for more complete staging.

Fresh HandlingEdit

Fix in formalin.

Grossing InEdit

  • Dissect tissue to identify nodes. Regions of scarring related to prior SLN biopsy may be present. Try to identify nodes here; just submit the tissue if unsure.
  • Describe maximal size of nodes and any gross evidence of tumor.
  • Submit nodes in toto, bisecting if necessary.
    • Bisected nodes should go in their own cassette(s) so that the two halves can be put back together.
    • Alternative approach: ink nodes in different colors to allow the halves to be matched up (“differential inking”).
    • Grossly positive nodes do not need to be submitted in toto. One section, including any area suspicious for extracapsular extension, is sufficient.

Submit the case in a bucket designated for “breast”, “fat”, or “16 hour” processing (all of these mean the same thing).

Sample DictationEdit

The specimen consists of an axillary dissection measuring ___ x ___ x ___ cm, dissected to reveal fat and multiple lymph nodes measuring up to ___ cm, (without gross evidence of disease) OR (one of which contains a firm white area suspicious for metastatic tumor, without extracapsular extension). There is a matted area measuring ___ cm in greatest dimension, potentially corresponding to the previous sentinel node biopsy. The nodes are submitted in toto as follows: ___-___, one node bisected per cassette; ___, additional nodes. The remaining fatty tissue is not submitted.

Review and SignoutEdit

1. Lymph nodes, right axilla, dissection:

___ lymph nodes, no tumor seen (0/___).
Metastatic carcinoma (___ cm focus) present in one out of ___ lymph nodes (1/___), without extracapsular extension.

Return to Breast Grossing

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