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Melanoma sentinel node protocol

 

Massachusetts General Hospital, Boston

 

Block 1

 

Mart1

H&E

MITF

S100

H&E

Blank

HMB45

H&E

Unstained

 

Subsequent blocks (Block 2, 3, …)

 

H&E

Melan A

H&E

Unstained
H&E

 

Emory

Routine H&E (no levels), S100 and Melan A

 

Univ Conn

Three levels H&E and one each of HMB45 and melan-A.

Univ Virginia

Bread-loafed at 2 mm intervals and then totally embedded and 3 H&E sections are cut at levels targeting to get in about half the block thickness. No routine IHC is done

Methodist in Houston

Three HE levels, alternating with 3 unstained for IHC

If H&Es are negative, IHCs for melan A and HMB 45 on every block

 

Mount Sinai

5 levels plus IHC for melan A, HMB 45

 

Cornell

Three H&E levels, plus S100, HMB45 and Melan-A (A103 antibody) 

 

Vanderbilt

Cut node into 2mm thick sections, 3 H&E levels; 1 MelanA 

 

Univ Utah

H&E

S100

Melan A

 

UCSF

3 levels, S100 at level 3. Save unstained slides from 3rd level for possible additional IHC.


 

Breast sentinel node

 

Massachusetts General Hospital, Boston

 

Breast

H&E

AE1.3/cam5.2

Keratin7

WS keratin

 

Emory

Some cases (some cases of some surgeons) undergo frozen sections. For those we do 1 H&E level +/- FS  levels (x2).

If not frozen, then regular HE. No routine IHC any longer, but most of us do cytokeratins in SLN from patients with lobular carcinoma (almost routine).

Univ Connecticut

Three levels H&E and cytokeratin AE1/AE3.

Univ Virginia

Bread-loafed at 2 mm intervals and then totally embedded and 3 H&E sections are cut at levels targeting to get in about half the block thickness. No routine IHC is done

Methodist Houston

For infiltrating lobular carcinomas we routinely do cytokeratin IHC on each block

For infiltrating ductal ca, up to pathologist discretion - uncommonly done

 

Mount Sinai

5 levels plus IHC for low molec wt keratin, AE1/AE3

 

Cornell

One H&E, no levels, plus CK (AE1/AE3)

 

Vanderbilt

Cut node into 2mm thick sections; one H&E level; no IHC

 

Univ Utah

1 H&E. No IHC unless something suspicious on H&E.

 

UCSF

3 levels, no IHC. Save unstained between levels in case IHC is needed