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Recommendation
Sentinel node biopsy – Pathological assessment
In order to allow staging as per American Joint Committee on Cancer (AJCC) criteria, sentinel lymph nodes must be examined pathologically by a method which ensures detection of all clinically significant metastases (i.e. 2 mm or greater). All lymph node tissue should be processed. Immunohistochemistry can be used selectively.
The first priority in histologic evaluation of lymph nodes is to identify all macrometastases (metastases larger than 2.0 mm). The entire lymph node should be submitted for evaluation and larger nodes should be bisected or thinly sliced no thicker than 2.0 mm. A single histologic section of each slice has a high probability of detecting all macrometastases present, although the largest dimension of the metastases may not be represented. More comprehensive evaluation of lymph node paraffin blocks is not required for categorization; however, such techniques as multilevel sectioning and immunohistochemistry (IHC) will identify additional tumor
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How this guidance was developed
This recommendation was based on the current American Joint Committee on Cancer (AJCC) Staging manual (eighth edition 2017). Although not developed as a clinical practice guideline, the AJCC Staging Manual was based on a comprehensive systematic review of the evidence. Because of the importance of this aspect of care and the strong evidentiary basis of the AJCC Staging Manual, it was agreed that this guidance should be a recommendation rather than a practice point. The guidance from the AJCC Staging Manual was simplified.
Sentinel node biopsy – Pathological assessment
Recommendation
In order to allow staging as per American Joint Committee on Cancer (AJCC) criteria, sentinel lymph nodes must be examined pathologically by a method which ensures detection of all clinically significant metastases (i.e. 2 mm or greater). All lymph node tissue should be processed. Immunohistochemistry can be used selectively.
Principles in action
Safe and quality care
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Care coordination
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This recommendation was based on the current American Joint Committee on Cancer (AJCC) Staging manual (eighth edition 2017). Although not developed as a clinical practice guideline, the AJCC Staging Manual was based on a comprehensive systematic review of the evidence. Because of the importance of this aspect of care and the strong evidentiary basis of the AJCC Staging Manual, it was agreed that this guidance should be a recommendation rather than a practice point. The guidance from the AJCC Staging Manual was simplified.