Intraoperative evaluation of axillary sentinel lymph nodes using touch imprint cytology and immunohistochemistry. Part II. Results
Introduction
There is a need for selective axillary surgery to avoid the complications of ANC in patients with early breast cancer. SNB is considered an accurate method for detecting axillary lymph node status in patients with early breast cancer.1, 2 However, there is no universal agreement on the optimal method for the intraoperative examination of the sentinel nodes.3, 4, 5, 6 The use of IHC might increase the sensitivity of imprint cytology and make its interpretation by a non-cytopathologist easier. We have previously described a protocol for the intraoperative immunostaining of axillary node touch imprints.7 We report here the final results of this study, whose preliminary results were reported earlier on.8
Section snippets
Material and methods
Fifty-two patients (23 ANC, 15 ANS and 14 SNB) who attended the University Hospital of Wales for treatment of early breast cancer (stages I and II) gave informed consent and took part in this study, which was approved by the Local Research Ethics Committee prior to its start. Some of the patients were among the ALMANAC (axillary lymphatic mapping against nodal axillary clearance) trial. The SNB procedure was done according to the standard protocol of the ALMANAC trial.
Four hundred and
Results
Four hundred and thirty-two nodes from the 52 patients in the study were examined by both IHC imprints and routine H&E pathology.
On IHC imprints, 12 patients had positive axillary nodes, with a total of 32 positive nodes. On H&E sections, only 11 patients had positive axillary nodes, with a total of 31 positive nodes. IHC imprints missed metastases in three nodes and missed the diagnosis of a positive axilla in two patients. Routine H&E pathology missed metastases in four nodes and missed the
Discussion
Results of IHC imprints in this study were concordant with results of other imprint cytology methods published by Motomura et al.,5 Ratanawichtrasin et al.,12 Rubio et al.4 and Anastasiadis et al.13
In a recent publication, Lambah et al.14 reported their results of using anti-cytokeratin immunostaining of imprint cytology as an intraoperative diagnostic tool for the assessment of axillary lymph nodes. They studied 238 nodes from 53 patients with early breast cancer. Imprints were stained with
Conclusion
Immunostained imprint cytology is a reliable method for intraoperative detection of metastatic axillary nodes. Combined with sentinel node biopsy, it can spare patients with positive axillae a second axillary procedure, and patients with negative axillae complications of unnecessary routine axillary clearance. Immunostaining of touch imprints is also an easy technique that aids the interpretation of the slides by non-cytologists and can be widely used.
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Cited by (30)
Sentinel node biopsy in breast cancer revisited
2014, SurgeonCitation Excerpt :Touch imprint cytology of axillary sentinel nodes has also been used with similar sensitivities to frozen section. Depending on local expertise some centres found it to be feasible and a reliable method for evaluating axillary nodes.55 More recently intraoperative molecular analysis using RT-PCR has been reported, and many centres in the UK are using it.
Touch imprint cytology with cytokeratin immunostaining versus Papanicolau staining for intraoperative evaluation of sentinel lymph node metastasis in clinically node-negative breast cancer
2009, European Journal of Surgical OncologyCitation Excerpt :Detection of metastasis was easier using immunohistochemistry in combination with Papanicolaou staining, and the false-negative rate was decreased significantly. Salem and colleagues reported that by using immunostaining with an anti-cytokeratin antibody, a non-pathologist was able to diagnose SLN metastasis with the same accuracy as a histopathologist.13 However, even though the sensitivity of intraoperative detection of SLN metastasis could be increased by combining Papanicolaou staining and immunohistochemistry, there were four false-negative cases in the present study, including two cases of micrometastasis.
The sentinel node in breast cancer. Analysis after the validation phase of the technique
2009, Progresos en Obstetricia y GinecologiaIntra-operative imprint cytology for assessing the sentinel node in breast cancer - Results of its routine use over 8 years
2009, European Journal of Surgical OncologyCitation Excerpt :The sensitivity of macrometastasis was however 61.9% which was comparable to our study. The use of intra-operative immunohistochemistry in combination with imprint cytology has been described with promising results, although sample reporting took up to 45 min.30 The likely negative impact on theatre efficiency and productivity has limited the widespread utilisation of such techniques.
Sentinel lymph node biopsy: Review of the literature and guidelines for pathological handling and reporting
2007, Current Diagnostic PathologyEffect of sentinel-node biopsy on metastatic development in breast cancer
2006, Lancet Oncology