Breast 01

Abstract

Aims: The success of the ‘Sentinel Node Biopsy’ (SNB) in determining the axillary lymph node status necessitates an accurate and rapid method for intraoperative examination of the nodes in order to selectively operate on positive axillae during the same operative session. The aim of the study was to determine the feasibility and accuracy of IHC stained touch imprints in detecting axillary nodal metastases intraoperatively. Three hundred and forty‐four axillary nodes from 30 patients [23 axillary node clearance (ANC), 2 axillary node sampling (ANS) and 5 SNB], were bisected, imprinted and stained with IHC. Results were compared with those of H&E sections of the same nodes. Results: Using IHC, 29 nodes from 9 patients were positive for metastases. Using H&E, 28 nodes from 8 patients were positive, resulting in 30 per cent and 27 per cent positive cases and 8.4 per cent and 8.1 per cent positive nodes for IHC and H&E, respectively. On a patient basis, sensitivity was 100 per cent and 89 per cent, and negative predictive value (NPV) was 100 per cent and 95.5 per cent for IHC and H&E, respectively. On a node basis, sensitivity was 96.7 per cent and 93.3 per cent and NPV was 99.6 per cent and 99.5 per cent for IHC and H&E, respectively. Because of the absence of false positives, specificity and positive predictive value (PPV) were 100 per cent for both IHC and H&E. With ANS and SNB procedures, results were obtained within 35–50 min depending on the number of the nodes given. Conclusion: These results indicate that IHC stained touch imprints can provide a fast and sensitive method for detecting metastases in axillary nodes during breast cancer surgery.

Investigation of support vector machines and Raman spectroscopy for lymph node diagnostics

“…For the first step of the SVM optimisation only a subset of the training data was used in order to maintain a manageable training time. For the linear kernel the first parameter approximation showed that a C of 2 7 results in the highest LOOCV of 75.4%. A second parameter optimisation was carried for further optimising the previously estimated C. For this search the range of C was set from 2 6 to 2 8 with an increase of 2 0.25 and the whole training set was used.…”

“…6 Alternatively, methods have been developed to allow faster intraoperative assessment of lymph nodes. These methods, including imprint cytology 7,8 and frozen section analysis, 9 also showed wide variations in the accuracy of detecting metastasis when compared with traditional methods.…”

Detection of breast micro-metastases in axillary lymph nodes by infrared micro-spectral imaging

“…The processing of samples is accelerated for these techniques, involving an analysis time of approximately 30–60 minutes. Yet, both approaches report wide variation in their sensitivity to detect cancerous lesions: detection levels as low as 44% and as high as 93% when compared with conventional histology 7–13. These variations indicate that such methodologies do not solve the problems associated with screening lymph nodes.…”

“…3 However, this procedure is more time consuming and costly, and still relies on human microscopic inspection of the stained tissue for detection. Alternative techniques have been employed to facilitate faster intra-operative diagnosis of sentinel nodes, including imprint cytology, 7,8 and frozen section analysis. 9,10 The processing of samples is accelerated for these techniques, involving an analysis time of approximately 30-60 minutes.…”

“…Yet, both approaches report wide variation in their sensitivity to detect cancerous lesions: detection levels as low as 44% and as high as 93% when compared with conventional histology. [7][8][9][10][11][12][13] These variations indicate that such methodologies do not solve the problems associated with screening lymph nodes.…”