title: Touch imprint cytology with cytokeratin immunostaining versus Papanicolau staining for intraoperative evaluation of sentinel lymph node metastasis in clinically node-negative breast cancer.
abstract: OBJECTIVE
  This study investigated whether intraoperative assessment of SLN status in patients with clinically node-negative breast cancer was improved using touch imprint immunohistochemistry.
  
  
  METHODS
  Each SLN was cut into slices 2mm thick and evaluated intraoperatively by touch imprint cytology with Papanicolaou staining until the end of 2005, or by a combination of Papanicolaou staining and immunostaining with an anti-cytokeratin antibody from early 2006.
  
  
  RESULTS
  When intraoperative cytology of SLN in 85 patients who were clinically node-negative was evaluated with Papanicolaou staining, 81 patients were diagnosed as negative and four were positive. Intraoperative cytology with Papanicolaou staining had a sensitivity of 30%, specificity of 99%, false-negative rate of 70%, false-positive rate of 1.3%, and accuracy of 90.6%. When intraoperative cytology was done with immunohistochemistry plus Papanicolaou staining for SLN evaluation, 92 patients were diagnosed as negative and 17 patients were positive. Intraoperative cytology with immunohistochemistry had a sensitivity of 79%, specificity of 98%, false-negative rate of 21%, false-positive rate of 2.2%, and accuracy of 94.5%. Compared with intraoperative cytology using Papanicolaou staining alone, the combination of immunohistochemistry and Papanicolaou staining achieved a significant increase in sensitivity and a significant decrease in the false-negative rate.
  
  
  CONCLUSIONS
  Intraoperative SLN evaluation by imprint cytology with immunohistochemistry achieves a more accurate diagnosis of metastasis than imprint cytology alone. This combined method is considered useful for deciding whether to perform axillary lymph node dissection.
authors.affiliation: Division of Breast and Endocrine Surgery, Department of Surgery, Kinki University School of Medicine, Osakasayama, Osaka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Fujishima
authors.forename: M
authors.initials: M
authors.lastname: Watatani
authors.forename: H
authors.initials: H
authors.lastname: Inui
authors.forename: Y
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: N
authors.initials: N
authors.lastname: Yamamoto
authors.forename: T
authors.initials: T
authors.lastname: Hojo
authors.forename: K
authors.initials: K
authors.lastname: Hirai
authors.forename: M
authors.initials: M
authors.lastname: Yamato
authors.forename: H
authors.initials: H
authors.lastname: Shiozaki
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D007432:Intraoperative Period / Q000379:methods*; D007633:Keratins / Q000032:analysis*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D065006:Papanicolaou Test; D011237:Predictive Value of Tests; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013194:Staining and Labeling / Q000379:methods; D014626:Vaginal Smears
chemical_list: D007633:Keratins