Specimens received should be examined carefully to maximise lymph node yield. This is usually achieved by manual dissection of fixed tissue with careful examination by inspection and palpation.
Small lymph nodes, <5mm in maximum dimension, will not require dissection.
Lymph nodes > 5mm, serially section looking for grossly identifiable deposits.
Macroscopically involved lymph nodes may be bisected along the median plane to demonstrate the relationship of tumour to the capsule. One section of a macroscopically involved node is sufficient.
Where extracapsular extension is apparent or suspected, lines of dissection should extend through adjacent tissues to allow microscopic evaluation of extracapsular invasion.
The lymph node or tumour closest to the surgical margin should be so identified and sampled.
If skin is present any abnormal area should be sampled according to the skin protocol. In the absence of any abnormality one representative block is adequate.
The axillary contents can be divided into three anatomical levels if the surgeon has marked the specimen appropriately.4 The apical lymph node should be separately identified, if so designated by the surgeon.
Every lymph node identified should be examined histologically. The presence of matted lymph nodes or extension of tumour to edges in axillary clearance specimens is rare but should be reported if apparent to assist with radiation therapy planning.
The description of non-sentinel lymph nodes should include the location of nodes (as described by the clinician) according to the standard code.4
- Axilla level
- Internal mammary chain, specify interspace if provided.