Intraoperative analysis of sentinel lymph nodes by imprint cytology for cancer of the breast

Stephen A. Shiver, Andrew J. Creager, Kim Geisinger, Nancy D. Perrier, Perry Shen, Edward A. Levine

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: The utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes (SLN) attractive, because axillary lymph node dissection can be performed during the initial surgery if the SLN is positive. The optimal technique for rapid SLN assessment has not been determined. Both frozen sectioning and imprint cytology are used for rapid intraoperative SLN evaluation. Methods: A retrospective review of the intraoperative imprint cytology results of 133 SLN mapping procedures from132 breast carcinoma patients was performed. SLN were evaluated intraoperatively by bisecting the lymph node and making imprints of each cut surface. Imprints were stained with hematoxylin and eosin (H&E) and Diff-Quik. Permanent sections were evaluated with up to four H&E stained levels and cytokeratin immunohistochemistry. Imprint cytology results were compared with final histologic results. Results: Sensitivity and specificity of imprint cytology were 56% and 100%, respectively, producing a 100% positive predictive value and 88% negative predictive value. Imprint cytology was significantly more sensitive for macrometastasis than micrometastasis 87% versus 22% (P = 0.00007). Of 13 total false negatives, 11 were found to be due to sampling error and 2 due to errors in intraoperative interpretation. Both intraoperative interpretation errors involved a diagnosis of lobular breast carcinoma. Conclusions: The sensitivity and specificity of imprint cytology are similar to that of frozen section evaluation. Imprint cytology is therefore a viable alternative to frozen sectioning when intraoperative evaluation is required. If SLN micrometastasis is used to determine the need for further lymphadenectomy, more sensitive intraoperative methods will be needed to avoid a second operation.

Original languageEnglish (US)
Pages (from-to)424-427
Number of pages4
JournalAmerican Journal of Surgery
Volume184
Issue number5
DOIs
StatePublished - Nov 1 2002
Externally publishedYes

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Cell Biology
Breast Neoplasms
Neoplasm Micrometastasis
Lymph Node Excision
Lobular Carcinoma
Sensitivity and Specificity
Selection Bias
Frozen Sections
Hematoxylin
Eosine Yellowish-(YS)
Keratins
Sentinel Lymph Node
Lymph Nodes
Immunohistochemistry

Keywords

  • Breast cancer
  • Cytology
  • Mapping
  • Sentinel node
  • Surgery
  • Touch prep

ASJC Scopus subject areas

  • Surgery

Cite this

Intraoperative analysis of sentinel lymph nodes by imprint cytology for cancer of the breast. / Shiver, Stephen A.; Creager, Andrew J.; Geisinger, Kim; Perrier, Nancy D.; Shen, Perry; Levine, Edward A.

In: American Journal of Surgery, Vol. 184, No. 5, 01.11.2002, p. 424-427.

Research output: Contribution to journalArticle

Shiver, Stephen A. ; Creager, Andrew J. ; Geisinger, Kim ; Perrier, Nancy D. ; Shen, Perry ; Levine, Edward A. / Intraoperative analysis of sentinel lymph nodes by imprint cytology for cancer of the breast. In: American Journal of Surgery. 2002 ; Vol. 184, No. 5. pp. 424-427.
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abstract = "Background: The utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes (SLN) attractive, because axillary lymph node dissection can be performed during the initial surgery if the SLN is positive. The optimal technique for rapid SLN assessment has not been determined. Both frozen sectioning and imprint cytology are used for rapid intraoperative SLN evaluation. Methods: A retrospective review of the intraoperative imprint cytology results of 133 SLN mapping procedures from132 breast carcinoma patients was performed. SLN were evaluated intraoperatively by bisecting the lymph node and making imprints of each cut surface. Imprints were stained with hematoxylin and eosin (H&E) and Diff-Quik. Permanent sections were evaluated with up to four H&E stained levels and cytokeratin immunohistochemistry. Imprint cytology results were compared with final histologic results. Results: Sensitivity and specificity of imprint cytology were 56{\%} and 100{\%}, respectively, producing a 100{\%} positive predictive value and 88{\%} negative predictive value. Imprint cytology was significantly more sensitive for macrometastasis than micrometastasis 87{\%} versus 22{\%} (P = 0.00007). Of 13 total false negatives, 11 were found to be due to sampling error and 2 due to errors in intraoperative interpretation. Both intraoperative interpretation errors involved a diagnosis of lobular breast carcinoma. Conclusions: The sensitivity and specificity of imprint cytology are similar to that of frozen section evaluation. Imprint cytology is therefore a viable alternative to frozen sectioning when intraoperative evaluation is required. If SLN micrometastasis is used to determine the need for further lymphadenectomy, more sensitive intraoperative methods will be needed to avoid a second operation.",
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AU - Levine, Edward A.

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N2 - Background: The utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes (SLN) attractive, because axillary lymph node dissection can be performed during the initial surgery if the SLN is positive. The optimal technique for rapid SLN assessment has not been determined. Both frozen sectioning and imprint cytology are used for rapid intraoperative SLN evaluation. Methods: A retrospective review of the intraoperative imprint cytology results of 133 SLN mapping procedures from132 breast carcinoma patients was performed. SLN were evaluated intraoperatively by bisecting the lymph node and making imprints of each cut surface. Imprints were stained with hematoxylin and eosin (H&E) and Diff-Quik. Permanent sections were evaluated with up to four H&E stained levels and cytokeratin immunohistochemistry. Imprint cytology results were compared with final histologic results. Results: Sensitivity and specificity of imprint cytology were 56% and 100%, respectively, producing a 100% positive predictive value and 88% negative predictive value. Imprint cytology was significantly more sensitive for macrometastasis than micrometastasis 87% versus 22% (P = 0.00007). Of 13 total false negatives, 11 were found to be due to sampling error and 2 due to errors in intraoperative interpretation. Both intraoperative interpretation errors involved a diagnosis of lobular breast carcinoma. Conclusions: The sensitivity and specificity of imprint cytology are similar to that of frozen section evaluation. Imprint cytology is therefore a viable alternative to frozen sectioning when intraoperative evaluation is required. If SLN micrometastasis is used to determine the need for further lymphadenectomy, more sensitive intraoperative methods will be needed to avoid a second operation.

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