Intraoperative touch imprint cytology for the diagnosis of sentinel lymph node metastases in breast cancer

Chicken, Dennis W.; Kocjan, Gabrijela; Falzon, Mary; Lee, A C; Douek, Michael; Sainsbury, R; Keshtgar, Mohammed

doi:10.1002/bjs.5289

Cited by 31 publications

(24 citation statements)

References 16 publications

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Section: Discussionmentioning

confidence: 99%

“…25,26 Both of these studies concluded that the sensitivity of TIC was better for detecting macrometastases than micrometastasis. 25,26 A small study of 17 patients demonstrated that TIC was accurate in patients who had received preoperative chemotherapy. 27 Importantly, this study identified distinct TIC cytologic patterns in those patients treated with preoperative chemotherapy, which may confound accurate slide interpretation in this patient subgroup.…”

Section: Discussionmentioning

confidence: 99%

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Is intraoperative touch imprint cytology of sentinel lymph nodes in patients with breast cancer cost effective?

Jeruss¹,

Hunt²,

Xing³

et al. 2006

Cancer

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BACKGROUND.Sentinel lymph nodes (SLNs) are generally evaluated postoperatively, requiring 5–7 days for assessment. SLNs can also be evaluated intraoperatively by using touch imprint cytology (TIC), thus providing the surgeon immediate feedback and allowing for concurrent completion node dissection (CND) for positive SLNs. The authors hypothesized that TIC, when compared with standard postoperative SLN assessment alone, would permit a cost‐effective evaluation of SLNs in patients with clinically node‐negative breast cancer.METHODS.A decision‐analysis model was created to compare TIC with standard postoperative SLN assessment alone. Sensitivity and specificity of TIC were determined prospectively from 342 patients who underwent SLN biopsy assessed by both techniques. Short‐term health states associated with surgical staging were defined, and utilities were estimated using EuroQol‐5D. Base‐case analysis was performed to estimate quality‐adjusted life years and the incremental cost‐effectiveness ratio. Sensitivity analyses were performed to examine stability of model parameters.RESULTS.For each tumor stage, TIC was cost effective, and for patients with larger tumors (T3 and T4), TIC was the dominant strategy. The analysis was robust to changes in sensitivity and specificity of TIC, prevalence of metastasis, probability of complications, and cost. However, when utility associated with standard SLN assessment was 0.9 or greater, this became the preferred strategy.CONCLUSIONS.TIC is cost effective for assessing SLN metastasis intraoperatively. For patients with larger tumors, it is not only more effective, but also less costly than standard SLN assessment alone. TIC may be particularly useful for patients who experience significant anxiety while awaiting results of standard SLN assessment. Cancer 2006. © 2006 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Is intraoperative touch imprint cytology of sentinel lymph nodes in patients with breast cancer cost effective?

Jeruss¹,

Hunt²,

Xing³

et al. 2006

Cancer

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“…6 Reported sensitivity of TIC varies from 33.3 to 100%. [14][15][16] Overall sensitivity and specificity of TIC in the present study based on the number of the patients was 66.7% and 98.2%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Our TIC accuracy was consistent with other studies. 6,17 Sensitivity of TIC in our practice may be affected by preselection of gross node-positive patients by axillary ultrasound. In these situations, we normally proceed with ALND directly.…”

Section: Discussionmentioning

confidence: 99%

“…it is more difficult to perform, requires more time for processing and is associated with tissue loss, which might affect further histologial examinations) it is still more commonly used than TIC. 6 This project was a quality assurance practice to establish feasibility, time-to-report, as well as accuracy of performing intraoperative assessment of sentinel lymph nodes using touch imprint cytology in our centre. PATIENTS AND METHODS This prospective audit included 146 sentinel lymph nodes from 74 consecutive patients with invasive breast cancer.…”

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confidence: 99%

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Testing the Feasibility of Intra-Operative Sentinel Lymph Node Touch Imprint Cytology

Jahromi

Narayanan

MacNeill

et al. 2009

annals

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Ann R Coll Surg Engl 2009; 91: 336-339 336Sentinel lymph node biopsy (SLNB) is replacing routine axillary dissection and is the new standard for axillary staging in early breast cancer supported by some uni-centre and multi-centre randomised controlled trials.1,2 Sentinel lymph nodes are generally evaluated postoperatively, requiring 5-7 days for pathological assessment. Axillary clearance remains standard treatment for patients with axillary metastases identified on sentinel lymph node biopsy. Intra-operative assessment of the sentinel lymph nodes allows immediate and therapeutic completion of axillary dissection during the same anaesthetic session if nodes are found to be tumour-positive. 4 In addition, delayed axillary clearance after sentinel lymph node biopsy can be technically challenging with the potential risk of increased morbidity (particularly infection and seroma) and lower overall nodal yield. Intra-operative touch imprint cytology (TIC) will also help by avoiding the economic and psychological costs of a second operation and prevents further delay in the commencement of adjuvant systemic treatment, chemotherapy and radiotherapy for high-risk patients with confirmed node involvement. Frozen-section examination and TIC are two methods used for intra-operative evaluation of sentinel lymph nodes. Although frozen section examination is more expensive than TIC and has disadvantages (i.e. it is more difficult to perform, requires more time for processing and is associated with tissue loss, which might affect further histologial examinations) it is still more commonly used than TIC. This project was a quality assurance practice to establish feasibility, time-to-report, as well as accuracy of performing intraoperative assessment of sentinel lymph nodes using touch imprint cytology in our centre. PATIENTS AND METHODS This prospective audit included 146 sentinel lymph nodes from 74 consecutive patients with invasive breast cancer. All patients underwent axillary sentinel lymph node biopsy using combined blue dye and radiocolloid technique. Results of intra-operative touch imprint cytology using haematoxylin and eosin staining were compared with the definitive histopathology results. RESULTS Mean time to report touch imprint cytology was 25.7 ± 6.4 min (range, 15-40 min). Histopathology demonstrated metastasis in 25 sentinel nodes from 17 (23%) patients. Intra-operative touch imprint cytology detected 15 nodes in 11 patients, giving a sensitivity of 60% (nodes) and 66.7% (patients) and specificity of 99.2% (nodes) and 98.2% (patients) based on the number of nodes and patients involved, respectively. Touch imprint cytology failed to show metastatic involvement in 10 nodes from 6 patients; of these, five nodes had micrometastasis (< 2 mm) and the other five had macrometastasis. One touch imprint cytology positive node contained isolated tumour cells only. Using intra-operative touch imprint cytology made a change in treatment of 11(14.9%) patients, and spared second axillary procedure in 7 (9.4%) patients. CONCL...

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Optical scanning for rapid intraoperative diagnosis of sentinel node metastases in breast cancer

Keshtgar

Chicken

Austwick

et al. 2010

British Journal of Surgery

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Intraoperative touch imprint cytology for the diagnosis of sentinel lymph node metastases in breast cancer

Abstract: TIC is feasible and enables the rapid diagnosis of SLN metastases with an acceptable accuracy for clinical use in ductal carcinoma of the breast.

Cited by 31 publications

References 16 publications

Is intraoperative touch imprint cytology of sentinel lymph nodes in patients with breast cancer cost effective?

Is intraoperative touch imprint cytology of sentinel lymph nodes in patients with breast cancer cost effective?

Testing the Feasibility of Intra-Operative Sentinel Lymph Node Touch Imprint Cytology

Optical scanning for rapid intraoperative diagnosis of sentinel node metastases in breast cancer

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