Accuracy of intraoperative imprint cytology for sentinel lymph node evaluation in the treatment of breast carcinoma

Cox, Charles E.; Centeno, Barbara A.; Dickson, B S Dan; Clark, Bob; Nicosia, Santo V.; Dupont, Elisabeth; Greenberg, Harvey; Stowell, B S Nicholas; White, B S Laura; Patel, Jolly; Furman, Ben; Cantor, Alan; Hakam, Ardeshir; Ahmad, Nazeel; Diaz, Nils M.; King, B S Jeff

doi:10.1002/cncr.20738

Cited by 72 publications

(34 citation statements)

References 59 publications

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“…Different studies have compared these techniques with regard to the following three considerations -speed (required time-to-report), reliability and cost-effectiveness. 12,13 In our study, time-to-report TIC fitted comfortably with average times for completion of breast surgery. Although the average time taken for reporting TIC appears acceptable, the additional anaesthetic time in a minority of patients must be offset against the increased operating time involved in a delayed axillary clearance.…”

Section: Discussionmentioning

confidence: 54%

Testing the Feasibility of Intra-Operative Sentinel Lymph Node Touch Imprint Cytology

Jahromi

Narayanan

MacNeill

et al. 2009

annals

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Ann R Coll Surg Engl 2009; 91: 336-339 336Sentinel lymph node biopsy (SLNB) is replacing routine axillary dissection and is the new standard for axillary staging in early breast cancer supported by some uni-centre and multi-centre randomised controlled trials.1,2 Sentinel lymph nodes are generally evaluated postoperatively, requiring 5-7 days for pathological assessment. Axillary clearance remains standard treatment for patients with axillary metastases identified on sentinel lymph node biopsy. Intra-operative assessment of the sentinel lymph nodes allows immediate and therapeutic completion of axillary dissection during the same anaesthetic session if nodes are found to be tumour-positive. 4 In addition, delayed axillary clearance after sentinel lymph node biopsy can be technically challenging with the potential risk of increased morbidity (particularly infection and seroma) and lower overall nodal yield. Intra-operative touch imprint cytology (TIC) will also help by avoiding the economic and psychological costs of a second operation and prevents further delay in the commencement of adjuvant systemic treatment, chemotherapy and radiotherapy for high-risk patients with confirmed node involvement. Frozen-section examination and TIC are two methods used for intra-operative evaluation of sentinel lymph nodes. Although frozen section examination is more expensive than TIC and has disadvantages (i.e. it is more difficult to perform, requires more time for processing and is associated with tissue loss, which might affect further histologial examinations) it is still more commonly used than TIC. This project was a quality assurance practice to establish feasibility, time-to-report, as well as accuracy of performing intraoperative assessment of sentinel lymph nodes using touch imprint cytology in our centre. PATIENTS AND METHODS This prospective audit included 146 sentinel lymph nodes from 74 consecutive patients with invasive breast cancer. All patients underwent axillary sentinel lymph node biopsy using combined blue dye and radiocolloid technique. Results of intra-operative touch imprint cytology using haematoxylin and eosin staining were compared with the definitive histopathology results. RESULTS Mean time to report touch imprint cytology was 25.7 ± 6.4 min (range, 15-40 min). Histopathology demonstrated metastasis in 25 sentinel nodes from 17 (23%) patients. Intra-operative touch imprint cytology detected 15 nodes in 11 patients, giving a sensitivity of 60% (nodes) and 66.7% (patients) and specificity of 99.2% (nodes) and 98.2% (patients) based on the number of nodes and patients involved, respectively. Touch imprint cytology failed to show metastatic involvement in 10 nodes from 6 patients; of these, five nodes had micrometastasis (< 2 mm) and the other five had macrometastasis. One touch imprint cytology positive node contained isolated tumour cells only. Using intra-operative touch imprint cytology made a change in treatment of 11(14.9%) patients, and spared second axillary procedure in 7 (9.4%) patients. CONCL...

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Section: Discussionmentioning

confidence: 54%

Testing the Feasibility of Intra-Operative Sentinel Lymph Node Touch Imprint Cytology

Jahromi

Narayanan

MacNeill

et al. 2009

annals

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“…In the study by Creager, the use of imprint cytology did not show any difference in sensitivity, specificity or accuracy between ILC and IDC, whereas the sensitivity for detecting macrometastases in patients with ILC was higher than for detecting micrometastases [47]. Conversely, in the series by Cox et al, the same method was associated with lower sensitivity rates for ILC compared with IDC [48].…”

Section: Hormone-replacement Therapy and Lobular Cancersmentioning

confidence: 62%

Hormone-replacement therapy and lobular cancers: new deals and old myths

Biglia¹,

Mariani

Robba

et al. 2008

Expert Review of Endocrinology & Metabolism

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“…However, its limitations include relatively high false-negative results (range 0.9-9.0%) and underestimation of disease with a wide range (17), suggesting that it is necessary to perform intraoperative assessment for patients with DCIS diagnosed by core needle biopsy who may need SLNB. Studies have indicated that lobular histology may be more difficult to interpret using touch imprint cytology, leading to a higher false-negative rate (18). Lobular carcinomas were excluded in our study due to the limited number of cases (4 cases), and we focused on the ductal carcinoma type.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the misdiagnosis of sentinel lymph nodes using touch imprint cytology for early stage breast cancer

et al. 2011

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Abstract. Accurate intraoperative diagnosis of sentinel node metastasis enables the surgeon to make an immediate decision to proceed to axillary lymph node dissection (ALND), thereby avoiding the economic and psychological costs of a second operation. The present study aimed to evaluate the clinical value of touch imprint cytology (TIC) and investigate the potential factors associated with misdiagnosis. A total of 366 patients with Tis-T2 breast carcinoma were included after undergoing successful sentinel lymph node biopsy (SLNB). TIC was routinely performed intraoperatively, and the results were compared with definitive histological assessments of serial sections (SS) with hematoxylin and eosin (H&E) staining. A total of 992 SLNs from 366 patients were used in the study. Based on the final histological diagnosis, the sensitivity, specificity and overall accuracy of TIC was 76.6, 98.8 and 92.3%, respectively, on a per patient basis, and 79.9, 98.9 and 96.1%, respectively, on a per node basis. TIC was significantly more sensitive for macrometastasis than micrometastasis (80.0 vs. 28.6%, P<0.01). Of 9 total 'false positives', 3 were due to micrometastasis which were not identified by serial section with H&E staining, 4 were actual false-positives which were due to interpretation error, and 2 were due to sampling error. The majority of the false-negatives (28 of 30 SLNs) were due to micrometastasis in the SLNs (sampling error). In conclusion, TIC is feasible for clinical use and is able to detect macrometastasis in the SLNs of early stage invasive breast cancer patients with an acceptable accuracy while its ability to detect micrometastasis is limited.

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Accuracy of intraoperative imprint cytology for sentinel lymph node evaluation in the treatment of breast carcinoma

Cited by 72 publications

References 59 publications

Testing the Feasibility of Intra-Operative Sentinel Lymph Node Touch Imprint Cytology

Testing the Feasibility of Intra-Operative Sentinel Lymph Node Touch Imprint Cytology

Hormone-replacement therapy and lobular cancers: new deals and old myths

Factors associated with the misdiagnosis of sentinel lymph nodes using touch imprint cytology for early stage breast cancer

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