meanwhile BGICC In 2026, Professor Frédéric Penault-Lorca delivered an intensive, practice-oriented lecture examining the contemporary role of frozen section analysis in sentinel lymph node (SLN) evaluation. Her presentation emphasized that cryosectioning should no longer be considered a routine procedure, but an elective tool reserved for specific clinical scenarios where the results can significantly change management.

Changes in the clinical landscape of sentinel node evaluation

Professor Penault-Llorca began by highlighting how advances in surgical palliation have fundamentally changed the relevance of intraoperative SLN assessment. Data from a pivotal trial indicate that patients with one or two positive sentinel lymph nodes often do not require complete axillary dissection when treated with appropriate radiation therapy. As a result, immediate intraoperative decisions based on frozen section findings often no longer influence surgical management.

In this context, the central problem has shifted from the detection of any microscopic deposits to the identification of nodal disease that poses a sufficient burden to change postoperative treatment decisions.

What information really matters in SLN pathology?

The presentation emphasized that pathology reporting should focus on factors that influence downstream management. These include the number of lymph nodes involved, the size of the largest metastatic focus, and a clear classification of lymph node involvement as isolated tumor cells (ITC), micrometastasis, or macrometastasis.

Although extracapsular extension, if present, should be documented, Professor Penault-Llorca emphasized that limited extension does not necessarily imply a poorer outcome and does not automatically mandate escalation of axillary surgery. Its value lies primarily in comprehensive reporting rather than immediate surgical decision making.

Frozen section: from routine to selective use

Frozen section analysis was once routinely performed during SLN surgery, but its use has decreased significantly. Professor Penault-Llorca explained that intraoperative detection of ITCs and small micrometastases has little impact on immediate management and may lead to unnecessary overtreatment.

Therefore, frozen sections should be reserved when macroscopic metastatic disease is strongly suspected or when identification prompts an immediate change in surgical strategy, such as avoiding a second surgery in certain patients.

Issues after neoadjuvant therapy

After preoperative systemic therapy, the role of frozen sections becomes more complex. In this situation, the lymph nodes may show fibrosis, treatment effects, or scattered residual tumor cells, making interpretation more difficult.

Professor Penault-Llorca noted that patients may achieve complete pathological remission in the breast despite residual lymph node disease. In such cases, accurate pathological assessment remains important to guide the escalation of adjunctive systemic therapy and radiotherapy planning. When uncertainty exists, a comprehensive histological evaluation is essential rather than relying solely on frozen sections.

Importance of detailed pathology report

The talk highlighted the growing importance of sensitive reporting of pathology to guide personalized treatment. Key elements include documentation of resected or targeted lymph nodes, measurement of residual disease, assessment of treatment-related changes such as fibrosis or necrosis, and explicit description of extranodal extension, if present.

Such detailed reporting supports multidisciplinary decision-making and ensures that axillary management is consistent with the overall treatment strategy.

Will detecting everything help the patient?

A central theme of the presentation was a critical reassessment of pathological intensity. Professor Penault-Llorca asked a fundamental question: “Does thorough detection of minimal disease improve patient outcomes?” Based on current evidence, the answer is often “no.”

Detection methods that are too sensitive may identify diseases that do not warrant escalation of treatment, increasing the risk of overtreatment without clinical benefit. Therefore, the modern goal of SLN pathology is clinically meaningful stratification rather than maximal detection.

Current position of frozen section

In conclusion, Professor Penault-Llorca outlined the practical role of frozen section analysis in modern breast cancer treatment. This is no longer a routine component of SLN evaluation, but is primarily a selection tool used to avoid re-operation in carefully selected cases. For most patients, the final paraffin section pathology provides sufficient information to guide optimal treatment.

As axillary management continues to evolve toward de-escalation, pathology practice must adapt accordingly, prioritizing relevance, precision, and multidisciplinary integration over exhaustive intraoperative detection.

Other posts about BGICC include: Onco Daily