A new test that examines large sections of the sentinel lymph node- the first place breast cancer typically spreads- for genes that re expressed only by breast cancer could reduce the risk of recurrence and multiple surgeries.  The sentinel node, located in the armpit, filters lymphatic fluid from the breast.  The new assay is being used at the Medical College of Georgia (MCG) to examine half of the tissue in the sentinel lymph node.  Done during a lumpectomy, the sample represents more than 10 times the amount of tissue examined in traditional biopsies at the present time.  Since the test examines the tissue with molecular tools it is more sensitive, decreasing the number of false negatives. The presence of excessive amounts of the proteins mamoglobin and cytokeratin 19, both genes that are expressed more in breast cancer tissue, would indicate that the cancer has metastasized. MCG is the first place in Georgia to offer the test, which Time Magazine named one of the top-10 medical breakthroughs of 2007. When performing a traditional sentinel node biopsy, a surgeon removes a node, then the pathologist would cut that section in half and cut that section to a quarter of the original sample size.  That piece is then cut into wafer-thin slices from those sections, frozen, stained, and examined for cancer cells under a microscope. This technique, called frozen section, would be done during the lumpectomy surgery. If the tissue is positive for cancer cells, the surgeon removes more nodes from the patient, but if it is negative, the surgery is over.  The problem with that type of test is that the pathologists review more tissue slices during a confirmatory second test, called a permanent section and done a day later.  Permanent section tests are done the day after surgery because the tissue is set with a fixative that causes proteins in cells to harden for better examination.  The cancer cells may not have been present in the part of the node that we looked at the day before in the frozen section, but on the second day, cancer may be found in the other section. At the present time nearly 20 percent of women with negative nodes confirmed by a traditional biopsy end up having a recurrence and metastasis.  The new test performs both the traditional test and the new molecular test in parallel to provide the best care for our patients.  The larger the sample the better the chance of detecting the cancer during the intraoperative test. The test when approved will help provide better care to patients and better overall treatment.