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Two of the most important new developments in the surgical treatment of early-stage breast cancer include skin-sparing mastectomy and sentinel lymph node biopsy. Combining these surgical techniques may achieve an optimal aesthetic outcome while minimizing the potentially significant morbidity associated with axillary dissection. Therefore, we congratulate Stradling et al¹ on their insightful article that carefully describes the surgical nuances of these combined operative techniques. However, one potentially critical aspect of the combined procedure was not addressed. This concerns the intraoperative identification of axillary lymph node metastases. The false-negative rate for the detection of axillary metastases using frozen section and touch preparation techniques has been reported to be as high as 89%; at our institution it is about 54%.^2-3 Therefore, the true status of the sentinel lymph node may be available only after a permanent histologic examination several days following the procedure. Although the current standard of care is to perform . . . [Full Text of this Article]

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