Novel rapid-immunohistochemistry using an alternating current electric field for intraoperative diagnosis of sentinel lymph nodes in breast cancer

Abstract

Axillary lymph node status and pathological diagnosis of sentinel lymph nodes (SLNs) is a prognostic factor that influences management of postoperative therapy. Recent reports indicate that one-step nucleic acid amplification and hematoxylin and eosin (HE)-stained frozen sections are effective for intraoperative diagnosis of SLNs. In the present study, we report a rapid-immunohistochemical staining (R-IHC) method that enables intraoperative detection of SLN metastases within 16 min using an anti-cytokeratin antibody. This is the first report on SLN diagnosis using R-IHC in patients with breast cancer. We prospectively examined 160 dissected SLNs from 108 breast cancer patients who underwent surgery at our institute. The dissected SLNs were sectioned and conventionally stained with HE or immunohistochemically labeled with anti-cytokeratin antibody using R-IHC procedures. Intraoperative R-IHC analyses were completed within 16 min, after which diagnoses were made by two pathologists. The total time required for intraoperative diagnosis was about 20 min. In this study series, R-IHC detected four metastatic SLNs that were undetected using conventional HE staining (4/20, 20.0%). Compared with subsequent permanent diagnosis, R-IHC offered 95.2% sensitivity and 100% specificity. These findings indicate R-IHC is a clinically applicable technique that enables precise and quick intraoperative detection of micro- and macrometastasis in breast cancer.

The impact of the MIB-1 index on facial nerve outcomes in vestibular schwannoma surgery

“…Furthermore, rapid immunohistochemical methods based on alternating current electric fields are available to facilitate the interaction between antigen and antibody. These methods make it possible to determine the MIB-1 indices and the tumour proliferation activity intraoperatively [29,41]. Therefore, new treatment modalities that can downregulate inflammatory processes and enable the construction of highly personalised therapies, which can be used immediately after VS surgery in high-risk patients with worse postoperative facial nerve outcomes, are needed.…”

Pathological Examination of Sentinel Lymph Node Biopsy

“…İntraoperatif tanı aşamasında, gereken süreyi kısaltmak için çalışmalar, araştırmalar yapılmış, bazı merkezlerde hızlı İHK incelemler uygulamada yerini bulmuştur (1,41,43).…”

“…Frozen kesite uygulanan hızlı İHK boyama yönteminde (rapid-immünohistochemical staining "R-IHC" anticytokeratin antibody, AE1/AE3) işlem süresinin yaklaşık 16-20 dakika olduğu belirtilmiştir (31,43). Frozen kesit ve imprintlere sitokeratin (AE1/AE3) uygulandığında, mikrometastazların saptanma oranı artmıştır (1,31).…”

“…İnvaziv lobüler karsinomda imprintlere sitokeratin uygulandığında tanıya %12,9 katkı sağladığı belirtilmiştir (44). Postoperatif kesin tanı ile hızlı İHK sonuçları birlikte değerlendirilmiş, hızlı İHK sensitivitesi %95,2-85, spesifitesi %100 olarak bildirilmiş, bu yöntemin doğruluk ve maliyet açısından uygulanabilir olduğu vurgulanmıştır (41,43).…”

Magnetically Promoted Rapid Immunofluorescence Staining for Frozen Tissue Sections

“…2 To complete the staining during surgery, a number of rapid IHC methods have been reported to reduce the reaction time of these processes. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] For example, ultrasound irradiation shortens the antibody reaction time to 1.5 min, 3 while Hatta et al 3 reported that in addition to Brownian motion, stirring increased the stochastic collision between antibodies and antigens to enhance bond formation. Other rapid IHC systems also reduce the staining time with a stirring effect created using external energy such as microwaves 4,6,7 or an alternating current electric field, 13,14,17 reducing the method to <20 min (Table 1).…”