ABSTRACT
The main task for the pathologist is to examine sentinel nodes (SNs) for possible metastasis.1-5 This examination has to be done with more attention (‘ultrastaging’) than the usual central HE section, since a false-negative SN assessment leading to omission of lymph node dissection may lead to untreatable locoregional tumor outgrowth in tumorbearing lymph nodes that have been left behind. The SN evaluation will usually be done postoperatively If indicated, a complete lymph node dissection would then be performed in a second session. However, it would be a great advantage to the patient and surgeon if the regional lymph node dissection, when necessary, could be performed in the same operating session as the SN procedure and the excision of the primary tumor. This requires accurate and efficient intraoperative assessment of the SN by the pathologist. There are several ways for postoperative and intraoperative SN evaluation. These include histopathologic investigation, immunohistochemistry (IHC), imprint cytology, fineneedle aspiration cytology, flow cytometry, and molecular biologic analysis. Several review papers on the pathology of the SN have been published.1,5,6 The aim of this chapter is to provide an up-to-date discussion of the virtues and flaws of these different methods, and to present practical guidelines for the SN investigation in gynecologic cancers.
