Is Intraoperative Imprint Cytology Evaluation Still Feasible for the Evaluation of Sentinel Lymph Nodes for Lobular Carcinoma of the Breast?

Abstract

Background The evaluation of sentinel lymph nodes (SLNs) from a patient with lobular breast cancer is challenging. Metastatic lobular cancer is difficult to identify in SLNs because of its low-grade cytomorphology and its tendency to resemble lymphocytes. Intraoperative imprint cytology (IIC) is a rapid, reliable method for evaluating SLNs intraoperatively. We sought to reexamine our experience with this technique in the identification of invasive lobular breast cancer SLN metastases. Methods A retrospective review of a prospectively maintained database of IIC results of 1010 SLN mapping procedures for breast cancer was performed. From this cohort we reviewed SLN cases of lobular cancer. The SLNs were evaluated intraoperatively by bisecting the SLN. Imprints were made of each cut surface and stained with hematoxylin and eosin (H&E) and Diff-Quik. Permanent sections were evaluated with up to 4 H&E-stained levels and cytokeratin immunohistochemistry. IIC results were compared with final pathologic results. Results A total of 67 cases of pure invasive lobular cancer were identified. The sensitivity was 71%, specificity was 100%, and accuracy was 92%. No statistically significant differences in sensitivity, specificity, or accuracy were identified between the intraoperative detection of lobular carcinoma vs ductal carcinoma. The specificity has remained the same since 2004. However the accuracy (82% vs 92%; P = .09) and sensitivity (52% vs 71%; P = .02) has improved since 2004. Conclusions As we have previously shown, the sensitivity and specificity of IIC in evaluating lobular carcinoma is feasible and accurate. IIC continues to be a viable alternative to frozen section for intraoperative evaluation.

Synergy of cytological methods in the pathological staging of breast cancer: Axillary fine‐needle aspiration and intraoperative scrape cytology of the sentinel lymph node

“…We do not notice any significant difference in the sensitivity ( P values = .9470) and specificity ( P values = .6709) of ISC for lobular/ducto‐lobular and other cytotypes, in agreement with the findings of Creager et al and Howard‐McNatt et al regarding touch imprints and of Horvath et al and Taras et al about frozen sections. Furthermore, lack of differences in sensitivity and specificity between chemotherapy‐naive patients and patients receiving neoadjuvant chemotherapy demonstrates that the techniques we are discussing are additionally useful in this setting; however, the literature is not concordant on the use of SLNB in chemotherapy‐treated patients, with some authors in favor and others not in favor …”

Trafficking of phagocytic peritoneal cells in hypoinsulinemic-hyperglycemic mice with systemic candidiasis

“…The use of transgenic mouse line with fluorescent protein-labeled is another sophisticated methodology [35]. The imprinting is a simple methodology, routinely used for diagnostic in other situations, as in the evaluation of sentinel lymph nodes for lobular carcinoma of the breast cancer [36]. Several studies have demonstrated that the imprinting is superior to freezing, particularly in cases where the preservation of the tissue structure is not required [37-40].…”

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

“…Nevertheless, a higher probability of false-negative results has been recorded and the presence of micrometastasis cannot be excluded 11–13. Sensitivity also depends on the histologic type of the tumor, with lower rates of detection for lobular carcinoma (LC) in comparison with the more common ductal type 14,15. Additional immunohistochemical staining may aid in the detection of micrometastases even in LC and contributes to the increase of IC sensitivity 16.…”