Intraoperative evaluation of sentinel lymph nodes in breast cancer: comparison of frozen sections, imprint cytology and immunocytochemistry

Francz, Mónika; Égervári, Kristóf; Szöllősi, Zoltán

doi:10.1111/j.1365-2303.2010.00818.x

Cited by 24 publications

(24 citation statements)

References 39 publications

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“…False-positive results that could lead to unnecessary ALND are very rare. The sensitivity of 90% of our research compares favorably with other reported studies of IC and FS 12,22,23. Therefore, IC is definitely an easy, quick, sensitive, and accurate method for the intraoperative assessment of SLN in BC patients.…”

Section: Discussionsupporting

confidence: 77%

Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer

Petropoulou¹,

Kapoula²,

Mastoraki³

et al. 2017

BCTT

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IntroductionSentinel lymph node (SLN) biopsy is the gold standard for surgical staging of the axilla in breast cancer (BC). Frozen section (FS) remains the most popular means of intraoperative SLN diagnosis. Imprint cytology (IC) has also been suggested as a less expensive and equally accurate alternative to FS. The aim of our study was to perform a direct comparison between IC and FS on the same SLNs of BC cases operated in a single center by the same surgical team.Materials and methodsInto this prospective study we enrolled 60 consecutive patients with histologically proven T1–T3 BC and clinically negative axilla. Sentinel nodes were detected using a standard protocol. The SLN(s) was always assessed by IC as well as FS analysis and immunohistochemistry. Nevertheless, all intraoperative decisions were based on FS analysis.ResultsDuring the study period 60 patients with invasive BC were registered, with 80 SLNs harvested. Mean number of SLN(s) identified for each patient was 1.33. The sensitivity and specificity were 90% and 100%, respectively, for IC, and 80% and 100% for FS. Relevant positive/negative predictive values were 100%/98% for IC and 100%/96.15%, respectively, for FS. Overall accuracy was 98% for IC and 97% for FS. Therefore, statistically significant difference between the two methods in the detection of positive nodes was not elucidated (p=1.000).ConclusionsIC appeared to be marginally more sensitive than FS in detecting SLN metastatic activity. Overall accuracy was 98.75%. With regard to the primary lesion characteristics, we conclude that initial lesion size and lymphovascular invasion play a pivotal role in metastatic involvement of the SLN with the dimensions of metastasis bearing no correlation with tumor size. Therefore, IC appears to be a sensitive and accurate method for the intraoperative assessment of SLN in BC patients, but further studies are required to confirm this interesting data.

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Section: Discussionsupporting

confidence: 77%

Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer

Petropoulou¹,

Kapoula²,

Mastoraki³

et al. 2017

BCTT

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“…[8][9][10][11][12][13][14][15] To improve the intraoperative detection of metastatic carcinoma in SLNs, several investigations have shown the efficacy of immunohistochemical evaluation with anti-CK antibodies. Generally, the sensitivity of frozen sections with immunohistochemistry 14,[27][28][29] is better than that of TIC with immunohistochemistry [20][21][22][23][24][25][26] as well as nonimmunohistochemical examinations. Because the SDB method does not depend on the skill of pathologists in detecting metastasis by cytological and pathological examinations, it may standardize the diagnostic procedure of metastasis to the SLN in breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, intraoperative touch imprint cytology (TIC) has lower sensitivity in detecting metastasis of SLNs compared with pathological examinations . Therefore, to improve the sensitivity of intraoperative evaluation of SLNs in breast cancer, intraoperative rapid cytokeratin (CK) immunostaining is used with frozen sections or TIC …”

mentioning

confidence: 99%

“…[14][15][16][17][18][19] Therefore, to improve the sensitivity of intraoperative evaluation of SLNs in breast cancer, intraoperative rapid cytokeratin (CK) immunostaining is used with frozen sections or TIC. 14,[20][21][22][23][24][25][26][27][28][29] The development of new modalities for intraoperative diagnosis of metastasis to SLN has been attempted. As a result, efficient methods that use molecular markers for detecting SLN metastasis, such as one-step nucleic acid amplification (OSNA, Sysmex, Japan), are commercially available.…”

mentioning

confidence: 99%

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Novel diagnostic procedure for determining metastasis to sentinel lymph nodes in breast cancer using a semi‐dry dot‐blot method

Otsubo

Oikawa

Hirakawa³

et al. 2013

Intl Journal of Cancer

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We developed an easy, quick and cost-effective detection method for lymph node metastasis called the semi-dry dot-blot (SDB) method, which visualizes the presence of cancer cells with washing of sectioned lymph nodes by anti-pancytokeratin antibody, modifying dot-blot technology. We evaluated the validity and efficacy of the SDB method for the diagnosis of lymph node metastasis in a clinical setting (Trial 1). To evaluate the validity of the SDB method in clinical specimens, 180 dissected lymph nodes from 29 cases, including breast, gastric and colorectal cancer, were examined. Each lymph node was sliced at the maximum diameter and the sensitivity, specificity and accuracy of the SDB method were determined and compared with the final pathology report. Metastasis was detected in 32 lymph nodes (17.8%), and the sensitivity, specificity and accuracy of the SDB method were 100, 98.0 and 98.3%, respectively (Trial 2). To evaluate the efficacy of the SDB method in sentinel lymph node (SLN) biopsy, 174 SLNs from 100 cases of clinically node-negative breast cancer were analyzed. Each SLN was longitudinally sliced at 2-mm intervals and the sensitivity, specificity, accuracy and time required for the SDB method were determined and compared with the intraoperative pathology report. Metastasis was detected in 15 SLNs (8.6%), and the sensitivity, specificity, accuracy and mean required time of the SDB method were 93.3, 96.9, 96.6 and 43.3 min, respectively. The SDB method is a novel and reliable modality for the intraoperative diagnosis of SLN metastasis.Sentinel lymph node (SLN) biopsy is a common surgical procedure in clinically node-negative breast cancer patients. [1][2][3] An accurate assessment of metastasis of SLNs is vital for making decisions on the avoidance of unnecessary removal of axillary lymph nodes and the provision of appropriate adjuvant treatment for patients. SLN metastasis is usually detected by conventional modalities, including intraoperative hematoxylin and eosin (H&E)-based pathological examination of frozen sections, cytological observation of touch imprints or a combination of pathological and cytological examination, followed by definitive postoperative pathological examination of permanent sections.4-7 However, novel diagnostic modalities are desperately required. This is because of a heavy workload for pathology specialists in Japan and discordances between the intraoperative and postoperative pathological diagnosis of SLN metastasis, with a false-negative rate of 5-52%, [8][9][10][11][12][13][14][15] resulting in unnecessary reoperation of axillary dissection. Additionally, intraoperative touch imprint cytology (TIC) has lower sensitivity in detecting metastasis of

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“…Unfortunately, formalin induces significant chemical alterations that lead to loss of integrity of the biomolecules in the specimens and compromises many downstream molecular tests [36,37]. Alternatively, snap-freezing tissue samples better preserves the integrity of tissue biomolecules; however, frozen tissues require special conditions for storage and handling, and also result in lower histological quality, thus the pathological evaluation of frozen sections can be difficult for many diseases [38].…”

Section: Box 1 Pathology Surgical Pathologists and Cytogeneticistsmentioning

confidence: 99%

Why is it crucial to reintegrate pathology into cancer research?

Rodriguez‐Canales¹,

Éberlé²,

Jaffe³

et al. 2011

BioEssays

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The integration of pathology with molecular biology is vital if we are to enhance the translational value of cancer research. Pathology represents a bridge between medicine and basic biology, it remains the gold standard for cancer diagnosis, and it plays an important role in discovery studies. In the past, pathology and cancer research were closely associated; however, the molecular biology revolution has shifted the focus of investigators toward the molecular alterations of tumors. The reductionist approach taken in molecular studies is producing great insight into the inner workings of neoplasia, but it can also minimize the importance of histopathology and of understanding the disease as a whole. In turn, pathologists can underestimate the role of molecular studies in developing new ancillary techniques for clinical diagnosis. A multidisciplinary approach that integrates pathology and molecular biology within a translational research system is needed. This process will require overcoming cultural barriers and can be achieved through education, a more effective incorporation of pathology into biological research, and conversely an integration of biological research into the pathology laboratory.

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Intraoperative evaluation of sentinel lymph nodes in breast cancer: comparison of frozen sections, imprint cytology and immunocytochemistry

Abstract: In our study the combined accuracy of the three methods was the same as combining touch imprint cytology and frozen sections or touch imprint cytology plus rapid immunocytochemistry. Rapid immunocytochemistry provides an additional parameter and preserves tissue for permanent sections.

Cited by 24 publications

References 39 publications

Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer

Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer

Novel diagnostic procedure for determining metastasis to sentinel lymph nodes in breast cancer using a semi‐dry dot‐blot method

Why is it crucial to reintegrate pathology into cancer research?

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