Intraoperative Evaluation of Sentinel Lymph Nodes for Metastatic Breast Carcinoma by Imprint Cytology

Abstract

Background: The increasing utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes attractive. Axillary lymph node dissection can be performed during the initial surgery if the sentinel lymph node is positive, potentially avoiding a second operative procedure. At present the optimal technique for rapid sentinel lymph node assessment has not been determined. Both frozen sectioning and intraoperative imprint cytology are used for rapid intraoperative sentinel lymph node evaluation at many institutions. The purpose of this study is to evaluate experience with imprint cytology for intraoperative evaluation of sentinel lymph nodes in patients with breast cancer. Methods: A retrospective review of the intraoperative imprint cytology results of 678 sentinel lymph node mappings for breast carcinoma was performed. Sentinel nodes were evaluated intraoperatively by either bisecting or slicing the sentinel node into 4 mm sections. Imprints were made of each cut surface and stained with H&E and/or Diff-Quik. Permanent sections were evaluated with up to four H&E stained levels and cytokeratin immunohistochemistry. Intraoperative imprint cytology results were compared with final histologic results. Results: The sensitivity of imprint cytology was 53%, specificity was 98%, positive predictive value was 94%, negative predictive value was 82% and accuracy was 84%. The sensitivity for detecting macrometastases ( more than 2mm) was significantly better than for detecting micrometastases (<2 mm), 81 versus 21%, respectively (P < 00001). Conclusions: The sensitivity and

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

“…In addition, Lee et al, 6 HenryTillman et al, 8 Llatjos et al, 4 and Van Diest et al 1 all used H & E alone as a gold standard, whereas most other studies used H & E in conjunction with CK immunohistochemistry. 2,10,11,13,16,21,29 Two apparent outliers in terms of reported accuracy are the studies of Motomura et al 2 and Henry-Tillman et al 8 Motomura and colleagues, who excluded clinically positive lymph nodes and analyzed lymph nodes from patients with T1-2 tumors using H & E alone or H & E with CK immunostaining as a reference, reported a remarkable sensitivity rate of 92% on the lymph node level.…”

“…1-4,6 -8,10,11,13,16,18,20 -22,29,35 Creager et al 13 analyzed the accuracy of IIC N strictly on the case level, which yields a higher sensitivity compared with lymph node-level analyses. 13 In addition, Creager et al, 13 Lee et al, 6 Cserni, 11 Ratanawichitrasin et al, 22 and Karamlou et al, 7 did not state whether patients with clinically positive lymph nodes were included in their studies. (The inclusion of such patients could affect the accuracy of IIC N .)…”

Spectrroscopic Sensing of Cancer and Cancer Therapy: Current Status of Translational Research

“…It is quick and easy to perform and gives similar results to frozen sections. [40][41][42] Both techniques, however, rely on the availability of a highly skilled pathologist, and it is likely that the excellent results reported from specialist units will not be replicated in smaller hospitals relying on a general pathologist for reporting. A real-time optical method for determining sentinel node involvement would provide significant benefits to patients undergoing surgery for breast cancer.…”

Sentinel node staging for breast cancer: intraoperative molecular pathology overcomes conventional histologic sampling errors

“…When compared with final permanent pathology results, the reported sensitivity of frozen section SLN analysis varies from 58% to 87% [1]. Touch preparation has similar limitations in sensitivity [2]. A positive intraoperative SLN finding spares the patient a later return to surgery for completion axillary dissection.…”