Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer

Abstract

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.

Evaluation of Sentinel Lymph Node Intraoperative Touch Imprint Cytology in Breast Cancer Surgery

“…At the present time, FS is still a most popular technique for intraoperative SLN assessment [26]. However, the procedure is expensive, labor intensive, time-consuming and operator dependent.…”

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

“…frozen section histology (FS) [ 2 ], touch imprint cytology (TIC) [ 3 ], immunohistochemistry [ 4 ] and infrared spectroscopy [ 5 ]. 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 ].…”

Cytologic smears improve accuracy of frozen sections of ovarian tumors in the community practice settings

“…The accuracy and importance of intraoperative cytologic preparations are well-documented in other organ systems, particularly in the central nervous system and breast sentinel lymph nodes. [1314]…”