SDN members see fewer ads and full resolution images. Join our non-profit community!

Cytokeratin staining on breast sentinel lymph nodes

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

  1. 2121115

    2121115 7+ Year Member

    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?
  2. SDN Members don't see this ad. About the ads.
  3. ForPath


    Sep 14, 2014
    We are doing CK only if tumor is lobular.
  4. coroner

    coroner Peace Sells...but who's buying? Physician 10+ Year Member

    Aug 3, 2007
    22 Acacia Avenue
    Last edited: Sep 26, 2014
  5. 2121115

    2121115 7+ Year Member

    Jan 23, 2007
    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 10+ Year Member

    Jan 16, 2008
    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.

    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.
  7. Alteran

    Alteran 7+ Year Member

    Feb 9, 2008
    Border war zone
    H&E, multiple levels. We go back and forth between doing'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

    Jun 16, 2008
    How do you survive without taking government insurance?
  9. BlondeDocteur

    BlondeDocteur 10+ Year Member

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

    pathstudent Sound Kapital 10+ Year Member

    Mar 17, 2003
    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.

Share This Page