Diagnostic Accuracy of Intraoperative Touch Imprint Cytology for the Diagnosis of Axillary Sentinel Lymph Node Metastasis of Breast Cancer: Comparison With Intraoperative Frozen Section Evaluation

Abstract

Introduction The intraoperative frozen section is a recommended method to detect breast cancer metastasis to axillary sentinel lymph nodes (SLNs); however, frozen section is not widely available and requires an experienced staff. Alternatively, touch imprint cytology (TIC) is a simple and cost-effective technique to detect metastasis. Therefore, in this study, we assessed the diagnostic accuracy of TIC for detecting SLN metastasis and compared it with intraoperative frozen section evaluation. Methodology A retrospective study was conducted in the Department of Histopathology, Liaquat National Hospital and Medical College, for a duration of two years. A total of 114 patients undergoing surgery for primary breast cancer were included in the study. All patients had clinically and radiologically negative axillary lymph nodes. SLN sampling was done using radioactive dye and sent for intraoperative consultation. The SLNs were sliced at 4-mm intervals and two TIC slides and three step-levels for frozen section were prepared, and the results were compared with final (paraffin) section histology. Results The sensitivity, specificity, and diagnostic accuracy of TIC was 83.7%, 98.5%, and 92.1%, respectively. Alternatively, the sensitivity, specificity, and diagnostic accuracy of frozen section was 93.9%, 100%, and 97.4%, respectively. The sensitivity of TIC and frozen section for detecting micrometastasis was 14.3% and 57.1%, respectively, with a diagnostic accuracy of 90.3% and 95.8%, respectively. Alternatively, with respect to macrometastasis, the sensitivity and specificity of TIC were 95.2% and 98.5%, respectively, while the sensitivity and specificity of frozen section were 100%. Conclusion TIC is a quick and effective technique for detecting breast cancer metastasis in axillary SLNs. Although frozen section had an overall higher sensitivity than TIC, the sensitivity of TIC for detecting macrometastasis was comparable to the frozen section. Therefore, we conclude that TIC is a good alternative to the frozen section in facilities where the frozen section is not available.

A Systematic Review and Meta‐analysis of Touch Imprint Cytology and Frozen Section Biopsy and Their Comparison for Evaluation of Sentinel Lymph Node in Breast Cancer

“…Fulltext reviews were performed and 16 were excluded for the following reasons: did not compare TIC and FSB (n = 10) and insufficient information to calculate TP/TN/FP/FN (n = 6). Finally, 14 studies were included in the metaanalysis [10][11][12][13][14][15][16][17][18][19][20][21][22][23].…”

Touch Imprint Intraoperative Flow Cytometry as a Complementary Tool for Detailed Assessment of Resection Margins and Tumor Biology in Liver Surgery for Primary and Metastatic Liver Neoplasms

“…Touch imprints have been extensively used in the cytological evaluation of tumor cells in several types of cancer, including primary and metastatic breast cancer [ 20 , 21 ], melanoma [ 22 ], as well as hepatic malignancies [ 23 ]. Touch imprint iFC offers several advantages to assist clinical management.…”

Quality assurance review: Intra‐operative evaluation of sentinel lymph nodes in breast cancer

“…Others such as Menes et al 18 have indicated that the sensitivity of touch preparation is comparable to that of FS and since touch preparation is more rapid and less expensive, uses less tissue, and does not create freezing artifacts, they concluded that touch preparation is the best available method for intraoperative evaluation of SLN. Newer studies also showed that IC is an effective and quick method for detecting macro‐metastasis in breast SLN 19,20 . One other limitation is that the documentation at the time of IOC was limited, and it was therefore impossible to accurately assess the adequacy of gross assessment as well as specimen sampling.…”

“…Newer studies also showed that IC is an effective and quick method for detecting macro‐metastasis in breast SLN. 19 , 20 One other limitation is that the documentation at the time of IOC was limited, and it was therefore impossible to accurately assess the adequacy of gross assessment as well as specimen sampling. The main finding in our study indicate that a maximum of three slides or three blocks for microscopic examination did not impact the sensitivity of SLN IOC.…”