title: Is intraoperative touch imprint cytology indicated in the surgical treatment of early breast cancers?
abstract: BACKGROUND
  Intraoperative touch imprint cytology (TIC) of the sentinel lymph node(s) (SLN(s)) in the treatment of breast cancer has significantly reduced the number of axillary block dissections (ABD) required during second surgeries. Based on recent studies, ABD was not considered necessary if the presence of tumor cells/micrometastasis was confirmed in the SLN(s) or in the case of macrometastases in a patient group meeting the inclusion criteria for the ACOSOG Z0011 study. Our aim was to determine the sensitivity and usefulness of TIC with regard to these results.
  
  
  METHODS
  TICs of the SLN(s) were examined in 1168 patients operated on for breast cancer. The method was also analyzed retrospectively based on the guidelines for the Z0011 study. During TIC, new samples were cut every 250 μm; impression smears were evaluated after being stained with hematoxylin eosin.
  
  
  RESULTS
  TIC confirmed metastasis in 202 cases (202/1168, 17.29%). Metastasis was confirmed in SLN(s) in 149 additional cases during a final histological examination. The sensitivity of TIC was found to be 57.18%, and its specificity was 99.63%. An analysis was then performed except for cases that met the inclusion criteria for the Z0011 study and with metastasis smaller than 2 mm (micrometastasis/isolated tumor cells) considered to be positive during intraoperative cytology. The sensitivity of the method decreased to 34.23%, while its specificity was still high at 99.76%.
  
  
  CONCLUSIONS
  Based on the new guidelines for ABD, imprint cytology cannot be considered a beneficial and cost-effective intervention in the surgical treatment of early breast cancer.
authors.affiliation: Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary. Electronic address: horvath.zoltan@med.u-szeged.hu.
authors.forename: Z
authors.initials: Z
authors.lastname: Horváth
authors.affiliation: Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary. Electronic address: paszt.attila@med.u-szeged.hu.
authors.forename: A
authors.initials: A
authors.lastname: Paszt
authors.affiliation: Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary. Electronic address: simonka.zsolt@med.u-szeged.hu.
authors.forename: Z
authors.initials: Z
authors.lastname: Simonka
authors.affiliation: Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary. Electronic address: latos.melinda@med.u-szeged.hu.
authors.forename: M
authors.initials: M
authors.lastname: Látos
authors.affiliation: Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary. Electronic address: viktorolah2@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Oláh
authors.affiliation: Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary. Electronic address: nagyszegi.dora@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Nagyszegi
authors.affiliation: Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Center, Allomás u. 2., Szeged, H-6720, Hungary. Electronic address: kaizer.laszlo@med.u-szeged.hu.
authors.forename: L
authors.initials: L
authors.lastname: Kaizer
authors.affiliation: Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Center, Allomás u. 2., Szeged, H-6720, Hungary. Electronic address: fejes.zsuzsanna@med.u-szeged.hu.
authors.forename: Z
authors.initials: Z
authors.lastname: Fejes
authors.affiliation: Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Center, Allomás u. 2., Szeged, H-6720, Hungary. Electronic address: hamar.sandor@med.u-szeged.hu.
authors.forename: S
authors.initials: S
authors.lastname: Hamar
authors.affiliation: Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Center, Allomás u. 2., Szeged, H-6720, Hungary. Electronic address: csorgo.erika@med.u-szeged.hu.
authors.forename: E
authors.initials: E
authors.lastname: Csörgő
authors.affiliation: Diagnoscan Hungary - Szeged, Semmelweis u. 6., Szeged, H-6725, Hungary. Electronic address: ormikati@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Ormándi
authors.affiliation: Diagnoscan Hungary - Szeged, Semmelweis u. 6., Szeged, H-6725, Hungary. Electronic address: lazarmate@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Lázár
authors.affiliation: Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary. Electronic address: lazar.gyorgy@med.u-szeged.hu.
authors.forename: G
authors.initials: G
authors.lastname: Lázár
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000556:secondary* / Q000601:surgery; D003581:Cytodiagnosis / Q000191:economics / Q000379:methods*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D061206:Neoplasm Micrometastasis / Q000175:diagnosis / Q000473:pathology; D061646:Operative Time; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000071036:Sentinel Lymph Node / Q000473:pathology* / Q000601:surgery
keywords: Axillary block dissection; Breast cancer; Intraoperative imprint cytology; Sentinel lymph node biopsy