{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T03:17:43Z","timestamp":1765595863501,"version":"3.48.0"},"reference-count":14,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2020,10,1]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:p>Clinical trials have shown that many patients with breast cancer with limited sentinel lymph node (SLN) metastatic disease can safely avoid axillary lymph node dissection. Ultra-staging of initially negative SLNs may not confer additional clinical benefit. Despite this, protocols of \u2018enhanced pathological examination\u2019 (EPE) are still widely used. We evaluated the impact of our EPE protocol. If initial SLN H&amp;Es are negative, we cut three additional H&amp;E levels at 500\u2009\u00b5m intervals with two spare sections at each level, to allow for immunohistochemistry if necessary. Occult micrometastases or isolated tumour cells were identified, using this protocol, in 3.4%, resulting in change of N stage in 3%. 1% of patients had further axillary surgery based on these findings. Our SLN-EPE protocol provided additional information in a small number of cases and changed axillary management in a minority. It represented a significant workload for scientists and pathologists, and had time and cost implications. We concluded that emphasising careful gross examination along with judicious use of additional levels and immunohistochemistry may be more beneficial than our current protocol.<\/jats:p>","DOI":"10.1136\/jclinpath-2020-206629","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T17:21:46Z","timestamp":1603387306000},"page":"746-749","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of an enhanced pathological examination protocol for sentinel lymph nodes from patients with breast carcinoma"],"prefix":"10.1136","volume":"74","author":[{"given":"Ciara","family":"Murray","sequence":"first","affiliation":[{"name":"Department of Histopathology, Saint James\u2019s Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asmaa","family":"Al Shehhi","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Saint James\u2019s Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ciar\u00e1n","family":"\u00d3'Riain","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Saint James\u2019s Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Dunne","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Saint James\u2019s Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9120-6383","authenticated-orcid":false,"given":"Aoife","family":"Maguire","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Saint James\u2019s Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,10,22]]},"reference":[{"key":"2025121219131730000_74.11.746.1","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1111\/his.12853","article-title":"Sentinel lymph nodes for breast carcinoma: an update on current practice","volume":"68","author":"Maguire","year":"2016","journal-title":"Histopathology"},{"key":"2025121219131730000_74.11.746.2","doi-asserted-by":"crossref","first-page":"S26","DOI":"10.1038\/modpathol.2010.36","article-title":"Pathology evaluation of sentinel lymph nodes in breast cancer: protocol recommendations and rationale","volume":"23 Suppl 2","author":"Weaver","year":"2010","journal-title":"Mod Pathol"},{"key":"2025121219131730000_74.11.746.3","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200306000-00018"},{"key":"2025121219131730000_74.11.746.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(10)70207-2"},{"key":"2025121219131730000_74.11.746.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1008108"},{"key":"2025121219131730000_74.11.746.6","doi-asserted-by":"crossref","DOI":"10.1200\/jco.2013.31.15_suppl.1000","article-title":"10-yr follow-up results of NSABP B-32, a randomized phase III clinical trial to compare sentinel node resection (SNR) to conventional axillary dissection (AD) in clinically node-negative breast cancer patients","volume":"31","author":"Julian","year":"2013","journal-title":"JCO"},{"key":"2025121219131730000_74.11.746.7","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70035-4"},{"key":"2025121219131730000_74.11.746.8","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(14)70460-7"},{"key":"2025121219131730000_74.11.746.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.90"},{"key":"2025121219131730000_74.11.746.10","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181f08f32"},{"key":"2025121219131730000_74.11.746.11","unstructured":"Ellis IO , Carder P , Hales S , et al . 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