Cytokeratin staining on breast sentinel lymph nodes

[2121115]

Just curious what the practice pattern is nationally for cytokeratin staining on breast sentinel lymph nodes. Are you all doing this in your practice or is it just H&E examination? When I was in training it was routine to order cytokeratin on breast sentinel lymph nodes and I know that many places still do this. What is the general rule where you are? Is there any good literature to guide practice on this issue or is there a consensus opinion of breast experts?

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[ForPath]

We are doing CK only if tumor is lobular.

 

[coroner]

Where I trained, we did a routine CK on negative sentinel nodes and I have carried that over into pratice as well. What's done in practice and what the literature and experts state does vary (sorta like routine H.P.'s on stomachs). Here's a few sources, the first supports what was said above as doing it only for lobular.

Journal of Clinical Pathology 2006; 59, 518-522

The American Journal of Surgical Pathology March 1999; Vol 23 - Issue 23, 263-267

 

[2121115]

Thanks for the input. We do CKs on the sentinel lymph nodes also. Just curious what was standard practice. I'd like to hear others' experiences as well.

 

[Path or bust]

Just curious what the practice pattern is nationally for cytokeratin staining on breast sentinel lymph nodes. Are you all doing this in your practice or is it just H&E examination? When I was in training it was routine to order cytokeratin on breast sentinel lymph nodes and I know that many places still do this. What is the general rule where you are? Is there any good literature to guide practice on this issue or is there a consensus opinion of breast experts?

Just realize that only the FIRST cytokeratin immuno is reimbursed (AE1/AE3 on one specimen and not per block). One way some people go around this is by performing different keratins, AE1/AE3 on block 1, CK7 block 2, Cam5.2 block 3 and so forth. The whole practice is gray but ASCO still goes back and forth on the significance of isolated tumor cells (ITCs) and micromets. http://jco.ascopubs.org/content/28/9/e141.full

Any breast guru have updated guidelines on the significance of this or what the literature indicates on the significance of isolated tumor cells?

I believe there is value in doing intraoperative Keratin immuno on sentinel lymph nodes, I am looking into a quick intraop keratin immuno procedure for our institution.
http://www.ncbi.nlm.nih.gov/pubmed/15474439

 

[Alteran]

H&E, multiple levels. We go back and forth between doing IHC...it's on a case by case basis really for us. We don't take government insurance, so if we have to bill IHC on multiple levels there's a better chance we're going to get reimbursed.

 

[stickyshift]

H&E, multiple levels. We go back and forth between doing IHC...it's on a case by case basis really for us. We don't take government insurance, so if we have to bill IHC on multiple levels there's a better chance we're going to get reimbursed.

How do you survive without taking government insurance?

 

[BlondeDocteur]

Academic hospital, in training (obv)-- multiple levels H&E only, no routine IHC.

 

[pathstudent]

it is still part of the TNM to group women together with isolated tumor cells, which can be nearly impossible to see without IHC in some instances. However, I think the literature is showing that women with micromets and ITCs have same survival with current therapies as women with negative sentinel nodes when other variables are matched. At some point it could be deemed pointless to do IHC on sentinel nodes for breast cancer.