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

Abstract

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...

Axillary nodal yields: A comparison between primary clearance and completion clearance after sentinel lymph node biopsy in the management of breast cancer

“…Our early TIC sensitivity of 67% was quite good [6] but TIC access was variable, dependant on pathologist availability and TIC sensitivity has declined in parallel with the increasing use of pre-operative axillary assessment. Axillary assessment involved pre-selection of the more obvious node positive axilla for pALND using ultrasound imaging with fine needle aspiration cytology (FNAC)/core biopsy of any suspicious nodes.…”

“…Indeterminate (C3) or suspicious (C4) results were considered as negative results. Our methodology and early results of IOA have been published [6].…”

Αξιολόγηση Μη Ψηλαφητών Συμπαγών Αλλοιώσεων Μασού Από Βιοπτικό Υλικό Υποβοηθούμενης Υπό Αναρρόφηση Βιοψίας (Μαμμοτόμε), Με Την Εφαρμογή Νέων Κυτταρολογικών Τεχνικών Και Ανοσοκυτταροχημείας

“…Εφαρμόζοντας διεγχειρητικά την μέθοδο των εντυπωμάτων στο φρουρό λεμφαδένα μπορεί το αποτέλεσμα να αλλάξει τον τρόπο της θεραπείας και να αποφευχθεί δεύτερο χειρουργείο για συμπληρωματικό λεμφαδενικό καθαρισμό [138,139,140].…”