Intraoperative touch preparation for sentinel lymph node biopsy: a 4-year experience.
BACKGROUND
The optimal technique for intraoperative pathologic examination of sentinel lymph nodes (SLNs) is still controversial. Recent small series report sensitivity between 60% and 100% for various techniques. The aim of this study was to evaluate our long-term experience with touch preparation cytology (TPC) and frozen section (FS) in the intraoperative examination of SLNs for breast cancer.


METHODS
A total of 247 patients with operable breast cancer underwent an SLN biopsy for staging of the axilla. The SLN was identified by (99m)Tc-labeled sulfur colloid unfiltered dye, blue dye, or both and dissected, and then intraoperative TPC or FS and permanent section, or both, were performed.


RESULTS
A total of 479 SLNs were submitted for TPC and permanent hematoxylin and eosin. A total of 68 SLNs were positive by hematoxylin and eosin; 65 SLNs were positive by TPC, with a false-negative rate of 5.8%. The sensitivity for TPC was 94.2%, with a false-positive rate of 0.2%. A total of 165 SLNs were submitted for FS, with a sensitivity of 85.7% and a specificity of 98.6%. The false-positive rate was 1.4%, with a false-negative rate of 15.8%.


CONCLUSIONS
In a large series, TPC is as accurate as FS but is simpler and faster in the detection of intraoperative metastasis in SLNs for breast cancer.
Henry-Tillman
Ronda S
RS
University of Arkansas for Medical Sciences, Akansas Cancer Research Center, Department of Veterans Affairs, Central Arkansas Veterans Healthcare System, Department of Surgery, Little Rock, Arkansas 77205, USA. henryrindas@uams.edu
Korourian
Soheila
S
Rubio
Isabel T
IT
Johnson
Anita T
AT
Mancino
Anne T
AT
Massol
Nicole
N
Smith
LaNette F
LF
Westbrook
Kent C
KC
Klimberg
V Suzanne
VS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013671:Technetium Tc 99m Sulfur Colloid
D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid