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IntroductionEdit

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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