Cytokeratin staining on breast sentinel lymph nodes

Discussion in 'Pathology' started by 2121115, Sep 26, 2014.

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  1. 2121115

    2121115 7+ Year Member

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    Jan 23, 2007
    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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  3. ForPath

    ForPath

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    We are doing CK only if tumor is lobular.
     
  4. coroner

    coroner Peace Sells...but who's buying? 7+ Year Member

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    Physician
    Last edited: Sep 26, 2014
  5. 2121115

    2121115 7+ Year Member

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    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.
     
  6. Path or bust

    Path or bust I like meat 7+ Year Member

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    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
     
  7. Alteran

    Alteran 7+ Year Member

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    Border war zone
    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.
     
  8. stickyshift

    stickyshift 7+ Year Member

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    How do you survive without taking government insurance?
     
  9. BlondeDocteur

    BlondeDocteur 7+ Year Member

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

    pathstudent Sound Kapital 10+ Year Member

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    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.
     

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