Is intraoperative touch imprint cytology indicated in the surgical treatment of early breast cancers?

Abstract

Introduction: Intraoperative touch imprint cytology (TIC) of the sentinel lymph node(s) (SLN(s)) in the treatment of breast cancer has significantly reduced the number of axillary block dissections (ABD) required during second surgeries. Based on recent studies, ABD was not considered necessary if the presence of tumor cells/micrometastasis was confirmed in the SLN(s) or in the case of macrometastases in a patient group meeting the inclusion criteria for the ACOSOG Z0011 study. Our aim was to determine the sensitivity and usefulness of TIC with regard to these results. Methods: TICs of the SLN(s) were examined in 1168 patients operated on for breast cancer. The method was also analyzed retrospectively based on the guidelines for the Z0011 study. During TIC, new samples were cut every 250 mm; impression smears were evaluated after being stained with hematoxylin eosin. Results: TIC confirmed metastasis in 202 cases (202/1168, 17.29%). Metastasis was confirmed in SLN(s) in 149 additional cases during a final histological examination. The sensitivity of TIC was found to be 57.18%, and its specificity was 99.63%. An analysis was then performed except for cases that met the inclusion criteria for the Z0011 study and with metastasis smaller than 2 mm (micrometastasis/isolated tumor cells) considered to be positive during intraoperative cytology. The sensitivity of the method decreased to 34.23%, while its specificity was still high at 99.76%. Conclusions: Based on the new guidelines for ABD, imprint cytology cannot be considered a beneficial and cost-effective intervention in the surgical treatment of early breast cancer.

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

“…However, recent studies have stated that TIC is not anymore, a useful technique to detect SLN metastasis in breast cancer [17,18].…”

“…In literature, TIC specificity reached 100% in most of cases, whereas its sensitivity ranges between 69% to 99%. What lowers TIC sensitivity is the detection of micrometastases, which go unnoticed in 84% of cases [17]. This means that false positive results, leading to unnecessary axillary dissection, are quite uncommon, whereas false negative rates are extremely variable, involving mostly micrometastasis.…”

Prospective Comparison of Intraoperative Touch Imprint Cytology and Frozen Section Histology on Axillary Sentinel Lymph Nodes in Early Breast Cancer Patients

“…In a retrospective analysis of 1,168 patients who underwent TIC, Horváth et al [8] reported a sensitivity of 57.18% and a specificity of 99.63% for this procedure. They indicated that TIC was less suited for the detection of metastases ≤2 mm, with 84.15% of micrometastases remaining undetected.…”

“…Nagashima et al [7] indicated that the specificity of TIC is high, but its sensitivity was low compared with FS. This low sensitivity could depend on its inability to identify micrometastases (≤2 mm) [8].…”

Feasibility of the use of touch imprint cytology for the assessment of axillary lymph nodes in breast cancer in the rural setting

“…TIC lacks adequate sensitivity with micrometastasis and has a sensitivity of 70.3 per cent with macrometasiasis. 10 TIC would have been a cheap, simple and effective method to assess the SLN intraoperatively but unfortunately lacks the required sensitivity and specificity required to properly assess the axilla in early breast cancer and therefore cannot be used in intra-operative assessment of the SLN.…”