title: Intraoperative touch imprint cytological analysis of sentinel lymph nodes for the presence of metastases in malignant melanoma.
abstract: OBJECTIVE
  Sentinel lymph node (SLN) biopsy has revolutionized lymph node staging in patients with malignant melanoma. Intraoperative evaluation is a new addition to the SLN procedure that allows for a one-step regional lymph node dissection to be performed when the SLN biopsy findings are positive. The discriminatory immunostaining pattern with the S-100 and HMB45 monoclonal antibodies allows intraoperative immunocytochemical evaluation of imprint smears of SLNs for melanoma metastases.
  
  
  METHODS
  One hundred twenty eight SLNs from a cohort of 52 patient-cases that had been identified using sulfur colloid as a radioactive tracer and isosulfan blue were bisected for rapid Diff-Quick stained touch preparations. Intraopera-tive evaluation of sentinel node status by imprint cytology was correlated with the histopathological results of permanent sections. Tumor-negative nodes in routine paraffin sections were further investigated with the employment of the S-100 and HMB45 antibodies.
  
  
  RESULTS
  Thirty-six of all SLNs harbored metastases in paraffin sections, from which 32 were identified by imprint cytology (sensitivity 88.8%). Three SLNs were positive by imprint cytology and negative by histopathology of paraffin sections. Comparison of the results of the touch preparations with the final histopathology (hematoxylin-eosin and S-100/ HMB45 stains) demonstrated a sensitivity of 83.3% and a negative predictive value of 92.5%. The specificity and positive predictive value were 100% respectively.
  
  
  CONCLUSIONS
  Touch imprint cytology is potentially useful for intraoperative evaluation of SLNs in malignant melanoma patients. Results can be improved if the surface sampled is appropriately enlarged and a rapid immunohistochemical S-100/HMB45 stain on the imprints is utilized.
authors.affiliation: Department of Cytology, Regional Hospital of Chania, Crete, Greece. cyto@chaniahospital.gr
authors.forename: D
authors.initials: D
authors.lastname: Tamiolakis
authors.forename: J
authors.initials: J
authors.lastname: Venizelos
authors.forename: T
authors.initials: T
authors.lastname: Jivanakis
authors.forename: C
authors.initials: C
authors.lastname: Antoniou
authors.forename: C
authors.initials: C
authors.lastname: Economou
authors.forename: N
authors.initials: N
authors.lastname: Tsiminikakis
authors.forename: G
authors.initials: G
authors.lastname: Georgiou
authors.forename: G
authors.initials: G
authors.lastname: Alexiadis
authors.forename: A
authors.initials: A
authors.lastname: Costopoulou
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal; D000951:Antigens, Neoplasm; D006801:Humans; D007118:Immunoassay / Q000379:methods; D007432:Intraoperative Period; D008207:Lymphatic Metastasis / Q000473:pathology; D008545:Melanoma / Q000556:secondary*; D058950:Melanoma-Specific Antigens; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000276:immunology; D009418:S100 Proteins / Q000276:immunology; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*
chemical_list: D000911:Antibodies, Monoclonal; D000951:Antigens, Neoplasm; D058950:Melanoma-Specific Antigens; D009363:Neoplasm Proteins; D009418:S100 Proteins