The value of intraoperative imprint cytology in the assessment of lymph node status in gastric cancer surgery

Abstract

gastrectomy with safe margins and routine lymphadenectomy, mostly more than D2 according to the Japanese classification [1]. So the evaluation of lymph node status was only possible in the late postoperative period through the histologic examination of formalinfixed surgical specimens, which means that surgeons had to perform lymphadenectomy without an exact knowledge of the lymph node status.From the development of the sentinel node concept in melanoma and breast cancer, numerous techniques have evolved to assess lymph node status intraoperatively, such as frozen section, imprint cytology, rapid immunostaining, and other molecular methods. Through these techniques, surgeons have been able to avoid unnecessary lymph node dissection with an acceptable risk of an additional trip to the operation room.As more patients are now being diagnosed in the early stages of gastric cancer, many attempts are being made to reduce both the extent of lymph node dissection and the extent of gastric resection itself. Even though many studies have proposed risk factors which predict the likelihood of lymph node metastasis in gastric cancer, no single risk factor can perfectly predict lymph node metastasis preoperatively. So performing limited surgery in gastric cancer patients without exact knowledge of lymph node status always carries a risk of residual nodal disease. Because reoperation to complete lymph node dissection carries the risk of additional morbidities, the need for accurate intraoperative diagnosis of lymph node metastasis is greater than ever.Here, we report the result of our study of the accuracy and usefulness of imprint cytology as a tool to assess lymph node status intraoperatively in gastric cancer surgery. AbstractBackground. The intraoperative assessment of lymph node status is important when performing limited surgery in gastric cancer patients. Currently available techniques for this assessment are frozen section, imprint cytology, and other molecular methods; most current studies use the frozen-section method. In the present study, we focused on the accuracy and feasibility of imprint cytology as a tool to assess lymph node status intraoperatively in gastric cancer surgery. Methods. Between April 2001 and March 2003, we performed imprint cytology of the sentinel nodes in 260 consecutive patients. After review by an experienced cytopathologist, the sensitivity, specificity, and overall accuracy of the method were determined. Results. The time required for the intraoperative imprint cytology was 8 min, and the sensitivity, specificity, and overall accuracy were 52.2%, 88.8%, and 73.8%, respectively. Conclusion. Imprint cytology could be a useful technique for the assessment of lymph node status intraoperatively if the sensitivity and specificity can be improved to an acceptable level.

Multicenter study evaluating the clinical performance of the OSNA assay for the molecular detection of lymph node metastases in gastric cancer patients

“…The accuracy of intraoperative detection of LN metastases from frozen sections or imprint cytology is lower than that from postoperative histological examination in patients with gastric cancer, breast cancer, and melanoma [20, 21]. As the OSNA assay demonstrated a diagnostic ability equivalent to that of the postoperative 2-mm-interval histological examination, this assay will be a useful tool for the intraoperative diagnosis of LN metastases in gastric cancer patients.…”

Identification of molecular biomarkers for the diagnosis of gastric cancer and lymph-node metastasis

“…Second, detecting INHBA expression during surgery may yield more accurate frozen-section diagnosis [31] and therefore select the superior modality between radical gastrectomy and the extent of lymphadenectomy, such as for uncertain enlarged LNs beyond the scope D2 resection. This is because the analysis of frozen sections during operation has some inherent problems, since it uses less than 1% of tissues in a node for analysis and therefore may result in comparatively low to moderate diagnostic sensitivity (52.2%), specificity (88.8%) and overall accuracy (73.8%) [32]. In addition, the use of qRT-PCR was once limited because it takes a long time to obtain the results of qRT-PCR.…”

Gastric lymphatic mapping for sentinel node biopsy by natural orifice transluminal endoscopic surgery (NOTES)

“…This occurs in at least 5-10% of patients and perhaps even up to 15-20%. Furthermore, modern intraoperative analytical techniques mean that accurate intraoperative analysis is rapidly accomplishable [12,13]. Therefore the performance of sentinel node biopsy at the initiation of the surgical procedure may indicate that limited gastric and lymph basin resection margins will be sufficient to allow surgical cure in a specific patient and thus allow function-preserving operations instead of conventional radical operation.…”