Intraoperative touch imprint cytology for the diagnosis of sentinel lymph node metastases in breast cancer.
BACKGROUND
Intraoperative detection of sentinel lymph node (SLN) metastases enables the surgeon to take an immediate decision to proceed to completion axillary lymph node dissection (ALND). The aim of this study was to determine the accuracy of touch imprint cytology (TIC) for the diagnosis of SLN metastases in sentinel nodes from women with breast cancer.


METHODS
Touch imprints from 235 sentinel nodes in 133 women with breast cancer were diagnosed by cytopathology and compared with definitive histopathology results. After a feasibility study, a real-time study was performed with the surgeon proceeding to ALND based on the TIC diagnosis. The clinical opinion of the operating surgeon as to whether the SLN appeared to contain metastases was recorded, as was the time taken for the result to be available.


RESULTS
TIC detected metastases with a sensitivity of 81.1 per cent and a specificity of 100 per cent. False-negative TIC diagnoses were associated with micrometastases and lobular carcinoma. The majority of false-negative diagnoses were due to sampling rather than interpretation errors. Clinical assessment of sentinel nodes had a sensitivity of 64.3 per cent and a specificity of 87.6 per cent.


CONCLUSIONS
TIC is feasible and enables the rapid diagnosis of SLN metastases with an acceptable accuracy for clinical use in ductal carcinoma of the breast.
Academic Department of Surgery, Royal Free and University College Medical School, University College London, UK.
D W
DW
Chicken
G
G
Kocjan
M
M
Falzon
A C
AC
Lee
M
M
Douek
R
R
Sainsbury
M R S
MR
Keshtgar
D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D010865:Pilot Projects; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000592:standards