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Bhoowit Lerttiendamrong, Nattanan Treeratanapun, Voranaddha Vacharathit, Kasaya Tantiphlachiva, Phuphat Vongwattanakit, Sopark Manasnayakorn, Mawin Vongsaisuwon Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandCorrespondence: Mawin Vongsaisuwon, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 King Chulalongkorn Memorial Hospital, Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand, Tel +66 897158888, Email mawin.v@chula.ac.thPurpose: Clinical application of the ACOSOG Z0011 trial results allows clinically node-negative breast cancer patients who meet criteria to avoid axillary dissection even when 1– 2 sentinel lymph nodes (SLNs) are positive for metastatic disease. Intraoperative frozen section (iFS) analyses of SLNs were thought to reduce re-operation rates despite variable reported sensitivity and possibility of a false negative result. This study evaluated the rate of re-operations prevented by SLN iFS in a tertiary care hospital in Bangkok, Thailand, over a 6-year time-frame.Patients and Methods: From April 2016 to April 2022, 1284 sentinel lymph node biopsy (SLNB) procedures were performed. Of these, 214 cases were breast-conserving surgery in accordance with the ACOSOG criteria with concomitant usage of iFS. Clinicopathological features of these cases were collected and analyzed. Re-operation rates prevented by the additional intervention were reported.Results: Only five additional operations were prevented with the usage of 214 iFS. The discordance rate between frozen and permanent sections in terms of presence of metastatic disease and number of total lymph nodes was around 15%. Tumor staging, node staging, Nottingham histologic grading and lymphovascular invasion are significant predictors of SLN metastasis.Conclusion: iFS results in a very low prevention rate for follow-up ALND in patients with preoperative clinically negative axillary nodes and is associated with a non-negligible discordan