High sensitivity of touch imprint cytology in young patients with invasive lobular carcinoma of the breast

Abstract

Invasive lobular carcinoma (ILC) of the breast is a rare type of breast cancer. Metastatic ILC is difficult to identify in sentinel lymph nodes (SLNs) because of its low-grade cytomorphology and its tendency to resemble lymphocytes. Touch imprint cytology (TIC) is a rapid method for evaluating SLNs intraoperatively. We sought to evaluate this technique in the identification of SLN metastases in ILC. A total of 230 SLNs from 88 patients diagnosed with ILC were examined with TIC, and the results were compared with their histological diagnosis. We first confirmed some typical cytological features of SLN metastases in ILC such as a thick eosinophilic background and hyperplasia of small cell lacking adhesion. Further analysis showed that sensitivity of TIC was 60.5 % on per-node basis and 58.3 % on per-patient basis; specificity of TIC was 100 % on per-node basis and 100 % on per-patient basis. Interestingly, when we divided patients according to their ages, the sensitivity of TIC in patients younger than 50 years old greatly increased to 90.9 % on per-node basis and 85.7 % on per-patient basis, whereas the specificity remained 100 % on both per-node basis and per-patient basis. However, different tumor sizes did not clearly change the sensitivity of TIC compared to the overall sensitivity. Patients with tumor size bigger than 1 cm revealed a TIC sensitivity of 59.4 % on per-node basis and 55.0 % on per-patient basis. These results suggest that TIC can be used as a reliable method of detecting SLN metastasis only in young patients with ILC.

Evaluation of intraoperative touch imprint cytology on axillary sentinel lymph nodes in invasive breast carcinomas, a retrospective study of 1227 patients comparing sensitivity in the different tumor subtypes

“…TIC is considered a more tissue conserving and less expensive method compared to FS with comparable accuracy [ 6 ]. The sensitivity of the TIC test on SLN in breast cancer is not consistent between studies, and seems to vary according to different tumor types, tumor size and the age of the patient [ 4 – 10 ]. Especially metastasis of invasive lobular carcinoma in the SLN is reported to be more difficult to identify on pathological examination compared to ductal carcinoma.…”

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.…”

Pre-operative and intra-operative detection of axillary lymph node metastases in 108 patients with invasive lobular breast cancer undergoing mastectomy

“…Low sensitivity of IIC in our Institute was probably due to the different preparation and fixation technique used for IIC at our Institute. In our study, the sentinel LN fat capsule was not always completely removed as described in other studies [ 21 ]. Furthermore, all our imprints were air-dried and stained with Hemacolor quick stain.…”

“…Furthermore, all our imprints were air-dried and stained with Hemacolor quick stain. Other studies with a higher sensitivity of IIC reported the use of two techniques combined, one being air drying and quick staining and the other an immediate 3-min fixation with ethanol and staining with hematoxylin and eosin (HE) [ 20 , 22 ], or only using 3-min ethanol fixation with HE staining [ 21 ].…”