engleski

Accuracy of intraoperative touch imprint cytology of sentinel lymph nodes in breast cancer

BACKGROUND: The sentinel lymph node (SLN) procedure is a method for ascertaining the axillary lymph node status in patients with breast cancer. Intraopearative examination of the SLN is important because a positive result directs surgery to a complete axillary lymph node dissection (ALND) and negative result avoids unnessesary lymphadenectomy. The purpose of this study was to evaluate the utility and accuracy of intraoperative touch imprint cytology (ITIC) in patients undergoing SLN for metastatic breast cancer. METHODS: Within three years (2003 – 2006) a total of 79 SLNs from 63 patients (62 female and one male) with T1 to T2 breast carcinoma were examined by ITIC. SLNs were identified by technetium-labelled sulphur colloid and blue dye. They were bisected along the long axis or sliced into 3 mm sections. Imprints were made of each cut surface, stained with Hemacolor rapid staining and reviewed by a cytologist. Later SLNs were submitted for paraffin embedding and serial sectioning. They were stained with HE and immunohistochemical staining for cytokeratin. Intraoperative imprint cytology results were compared with final histological diagnosis. RESULTS: Definitive histology revealed metastases in 17/63 patients (27%) in 20/79 SLNs (25%). Intraoperative cytology showed a sensitivity of 70%, a specificity of 94.9%, a negative predictive value of 90.3%, a positive predictive value of 82.4% and an accuracy of 88.6% per sentinel node basis. There were 6 false-negative cases due to micrometastases in the SLN and 3 “ false positives” in the group with 59 negative SLNs in 46 patients. CONCLUSION: Intraoperative touch imprint cytology of SLN in breast carcinoma patients is a simple, quick and accurate method for detecting metastatic disease in the SLN. Despite its limitations, ITIC evaluation of SLN could spare a second operation to a large number of patients with breast cancer. Results may be improved by an appropriate enlargement of the surface sampled and the use of rapid immunocytochemistry on the touch imprint smears

imprint cytology ; sentinel lymph node ; breast carcinoma

nije evidentirano