Intraoperative frozen section assessment of sentinel lymph nodes in the operative management of women with symptomatic breast cancer

Ali, R; Hanly, Ann; Naughton, Peter; Castineira, Constantino F; Landers, R.; Ra, Chisei; Watson, R. G. K.

doi:10.1186/1477-7819-6-69

Cited by 26 publications

(20 citation statements)

References 32 publications

(21 reference statements)

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“…The use of frozen-section histopathology of lymph nodes is also an accepted nodal assessment method, but often takes 20–30 min to perform, lengthening the time that the patient is under general anesthesia [7], [8]. Several other intraoperative techniques are currently under investigation, including touch imprint cytology [9], [10], molecular marker assays [11], frozen-section analysis [7], [8], and Fourier transform infrared microspectroscopy [12]. All these techniques require the physical sectioning of the lymph node, leading to the physical destruction of the nodal structural integrity and cellular architecture to perform the molecular assay, staining, or probing protocols.…”

Section: Current and Experimental Nodal Assessment Techniquesmentioning

confidence: 99%

Optical Coherence Tomography: The Intraoperative Assessment of Lymph Nodes in Breast Cancer

Nguyen

Zysk

Chaney

et al. 2010

IEEE Eng. Med. Biol. Mag.

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During breast-conserving surgeries, axillary lymph nodes draining from the primary tumor site are removed for disease staging. Although a high number of lymph nodes are often resected during sentinel and lymph-node dissections, only a relatively small percentage of nodes are found to be metastatic, a fact that must be weighed against potential complications such as lymphedema. Without a real-time in vivo or in situ intraoperative imaging tool to provide a microscopic assessment of the nodes, postoperative paraffin section histopathological analysis currently remains the gold standard in assessing the status of lymph nodes. Optical coherence tomography (OCT), a high-resolution real-time microscopic optical-imaging technique previously used to image breast cancer tumor margins intraoperatively in humans and lymph-node microarchitecture in a rat animal model, is being presented for the intraoperative ex vivo imaging and assessment of axillary lymph nodes. OCT provides real-time microscopic images up to 2 mm beneath the tissue surface in axillary lymph nodes. Normal (13), reactive (1), and metastatic (3) lymph nodes from 17 human patients with breast cancer were imaged intraoperatively with OCT. These preliminary clinical studies have identified scattering changes in the cortex, relative to the capsule, which can be used to differentiate normal from reactive and metastatic nodes. These optical scattering changes are correlated with inflammatory and immunological changes observed in the follicles and germinal centers. These results suggest that intraoperative OCT has the potential to assess the real-time node status in situ, without having to physically resect and histologically process specimens to visualize microscopic features. Breast CancerBreast cancer continues to affect a significant proportion of women, as 192,370 new cases of invasive breast cancer and 62,280 cases of ductal carcinoma in situ (DCIS) are expected in the United States during 2009, making it the most widely diagnosed cancer (26% of new cases) in women [1]. The number of deaths attributed to breast cancer (40,610 expected in 2009-second only to lung cancer) has started to decrease over the last few years, largely attributed to the effectiveness of breast-cancer screening [1]. These developments have led to the increased detection of breast-cancer lesions at earlier stages, resulting in smaller breast lesions and a decreased likelihood of lymph-node involvement and cancer metastasis. The management and treatment of breast cancer has continued to improve, as evidenced by the gradual increases in the five-year survival rates for all stages of breast cancer [2]. Currently, patients electing to undergo lumpectomies or mastectomies will typically have a sentinel lymph-node dissection (SLND), which may be accompanied by the removal of additional axillary lymph nodes via axillary lymph-node dissection (ALND) to help stage . Staging is based on the size of the primary tumor, the involvement of lymph nodes, and the metastatic spread to secondary sites. Ma...

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Section: Current and Experimental Nodal Assessment Techniquesmentioning

confidence: 99%

Optical Coherence Tomography: The Intraoperative Assessment of Lymph Nodes in Breast Cancer

Nguyen

Zysk

Chaney

et al. 2010

IEEE Eng. Med. Biol. Mag.

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“…These values are in line with typical values found in the literature. [34][35][36][37][38] The total population was however smaller (49 samples), since the FS analysis was performed on sentinel nodes while the FFOCT imaging could be performed on a bigger node population comprising SLN and nodes from ALND. Furthermore, different sentinel node halves were analyzed with each technique.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Sentinel Node Biopsies With Full-Field Optical Coherence Tomography

Grieve

Mouslim

Assayag

et al. 2015

Technol Cancer Res Treat

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Current techniques for the intraoperative analysis of sentinel lymph nodes during breast cancer surgery present drawbacks such as time and tissue consumption. Full-field optical coherence tomography is a novel noninvasive, high-resolution, fast imaging technique. This study investigated the use of full-field optical coherence tomography as an alternative technique for the intraoperative analysis of sentinel lymph nodes. Seventy-one axillary lymph nodes from 38 patients at Tenon Hospital were imaged minutes after excision with full-field optical coherence tomography in the pathology laboratory, before being handled for histological analysis. A pathologist performed a blind diagnosis (benign/malignant), based on the full-field optical coherence tomography images alone, which resulted in a sensitivity of 92% and a specificity of 83% (n ¼ 65 samples). Regular feedback was given during the blind diagnosis, with thorough analysis of the images, such that features of normal and suspect nodes were identified in the images and compared with histology. A nonmedically trained imaging expert also performed a blind diagnosis aided by the reading criteria defined by the pathologist, which resulted in 85% sensitivity and 90% specificity (n ¼ 71 samples). The number of false positives of the pathologist was reduced by 3 in a second blind reading a few months later. These results indicate that following adequate training, full-field optical coherence tomography can be an effective noninvasive diagnostic tool for extemporaneous sentinel node biopsy qualification.

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“…Ce test est basé sur l'amplification de l'ARNm de la cytokératine 19, protéine surexprimée par le tissu mammaire tumoral et normalement absente du ganglion indemne. Tamaki Ces analyses de biologie moléculaire posent le problème du coût et de l'absence de contrôle anatomopathologique, même si plusieurs études montrent la cohérence avec le résultat anatomopathologique [79,80].…”

Section: La Problématique De La Chirurgie Préalableunclassified

“…Même si cet examen extemporané ne permet le diagnostic de macrométastase que dans, globalement, 60 à 70 % des cas en fonction de la technique et de l'expertise, faire le choix de ne pas faire d'extemporanée amène de fait à réopérer 100 % des patientes présentant un e macrométastase. L'extemporanée permet donc bien de limiter le nombre de patientes devant être ré opérées pour curage axillaire.Il existe deux techniques anatomopathologiques pour réaliser cet examen: • l'examen cytologique par empreinte: technique rapide (cinq à dix minutes), peu coûteuse, préservant le tissu lymphoïde; sa sensibilité pour la détection des macromé-tastases est de 63 %[78]; • l'examen sur coupes congelées: il permet en principe de détecter des métastases de plus petite taille mais la réalisation est plus longue avec une perte de tissu; sa sensibilité pour les macrométastases est de 76 %[79].…”

unclassified

Chirurgie des cancers invasifs du sein (à l’exception de la reconstruction mammaire)

Classe¹,

Sentilhes

Jaffré³

et al. 2010

Journal de Gynécologie Obstétrique et Biologie de la Reproducti

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Intraoperative frozen section assessment of sentinel lymph nodes in the operative management of women with symptomatic breast cancer

Cited by 26 publications

References 32 publications

Optical Coherence Tomography: The Intraoperative Assessment of Lymph Nodes in Breast Cancer

Optical Coherence Tomography: The Intraoperative Assessment of Lymph Nodes in Breast Cancer

Assessment of Sentinel Node Biopsies With Full-Field Optical Coherence Tomography

Chirurgie des cancers invasifs du sein (à l’exception de la reconstruction mammaire)

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