The reliability and accuracy of intraoperative imprint cytology of sentinel lymph nodes in breast cancer

Pogačnik, Ana; Klopčič, Ulrika; Grazio-Frkovic, Snjezana; Žgajnar, Janez; Hočevar, Marko; Vidergar-Kralj, Barbara

doi:10.1111/j.1365-2303.2004.00212.x

Cited by 30 publications

(14 citation statements)

References 30 publications

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“…Another specific disadvantage of FS is that in case of a small-sized SLN the possibility of tissue destruction with parallel absence of material for final histological examination is apparent. Therefore, FS cannot be performed on occasion because of inadequate safety of protecting the permanent specimen 30–33. Moreover, LC cells are morphologically similar to lymphoid cells, thus making identification of metastases more challenging on both IC and definitive postoperative histology 34.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…5,7,11,15,16 The reasons for low sensitivity in certain studies may be poor quality of the imprints, presence of metastatic cells under the capsule of the lymph node or sometimes the larger group of cells is not imprinted because the cohesion between the epithelial cells is more than between the lymphoid cells. 15 The other limitations of practical significance are low volume metastases, metastases from lobular or low grade ductal carcinomas or a diffuse unicellular infiltrating pattern may remain undetected. 17 A few studies have reported sensitivity of imprint smears even better than frozen section which may be because of less number of cases having micrometastases and only a small percentage of lobular carcinoma cases.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative evaluation of sentinel lymph nodes in breast carcinoma by imprint cytology, frozen section and rapid immunohistochemistry

Sharma

Mohan

Handa

et al. 2009

Diagnostic Cytopathology

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Sentinel lymph nodes (SLN) isolated in 40 patients of breast carcinoma (stage T(1)/T(2)) were evaluated intraoperatively by imprint cytology and frozen section. Rapid immunohistochemistry (IHC) was done in cases where both imprint smears and frozen sections were negative for any metastatic tumor deposits. The results of these different techniques were compared with postoperative paraffin sections taken as "Gold Standard." Nottingham modification of Bloom Richardson scoring system was used for grading the tumors. Further, the correlation of the SLN status with tumor size, grade, and lymphovascular invasion was studied. The sensitivity, specificity, and overall accuracy of imprint cytology were 91.7, 100, and 95% respectively, and those of the frozen section were 95.8, 100, and 97.5% respectively. Examination of multiple serial sections improved the sensitivity and overall accuracy of frozen section. Results of intraoperative rapid IHC were equivalent to final paraffin sections. Histological grade and lymphovascular invasion were in direct correlation with SLN metastasis (P < 0.05). The risk of lymphovascular invasion increased from 22.2% in grade I tumors to 85.7% in grade III tumors. SLN biopsy is a reliable method to evaluate the status of the axillary lymph nodes. Imprint cytology can be used reliably where the facility of frozen section is not available.

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“…[16][17][18][19] The techniques used for the intraoperative evaluation of SLNs include frozen section analysis and imprint cytology. [20][21][22][23][24][25][26][27] Frozen section analysis has the advantage of high sensitivity but the disadvantages that the sections may undergo artefactual changes, tissue is consumed, and the procedure is time consuming. In contrast, imprint cytology can provide clear cytological details and a rapid diagnosis, preserving the tissue for permanent sections.…”

Section: Introductionmentioning

confidence: 99%

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

Francz¹,

Égervári²,

Szöllősi³

2010

Cytopathology

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The reliability and accuracy of intraoperative imprint cytology of sentinel lymph nodes in breast cancer

Abstract: Imprint of SLN biopsy can identify a negative axilla with high accuracy (specificity 99.2%). Overall sensitivity is only 36.5%, but macrometastases are detected in 77% which is important for performing ALDN in one session with operation of primary tumour.

Cited by 30 publications

References 30 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

Intraoperative evaluation of sentinel lymph nodes in breast carcinoma by imprint cytology, frozen section and rapid immunohistochemistry

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

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