Abstract
The widely practiced intra-operative methods for rapid evaluation and detection of sentinel lymph node (SLN) status include frozen section (FS) and touch imprint cytology (TIC). This study optimized the use of TIC and FS in the intra-operative detection of breast SLNs based on the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram. Three hundred forty-two SLNs were removed from 79 patients. SLN metastatic probability was assessed by the MSKCC nomogram. The SLNs underwent intra-operative TIC and FS, as well as routine post-operative paraffin sections (RPSs). The relationships between TIC, FS, and SLN metastatic probability were analyzed. Overall, TIC was more sensitive than FS (92.31% vs. 76.92%), while TIC specificity was inferior to FS specificity (84.85% vs. 100%). In addition, the best cut-off value for TIC based on the MSKCC nomogram was inferior to the best FS cut-off value (22.5% vs. 34.5%). All patients with a MSKCC value <22.5% in the present study were negative based on FS and RPS, while the true-negative and false-positive rates for TIC were 92.5% and 7.5%, respectively. Thus, early breast cancer patients, based on a MSKCC value <22.5%, can safely avoid FS, but should have TIC performed intra-operatively. Patients with a MSKCC value >22.5% should have TIC and FS to determine the size of metastases, whether or not to proceed with axillary lymph node dissection, and to avoid easily missed metastases.
Highlights
As the most common malignant disease and the second leading cause of cancer mortality in women, breast carcinoma poses a threat to women’s health [1, 2]
A study of one-step nucleic acid amplification assay (OSNA) in 552 patients showed both OSNA and touch imprint cytology (TIC) can serve as qualified intra-operative assessments of sentinel lymph node (SLN), and suggested that OSNA can be applied as a complement to histopathologic assessment, but cannot replace pathology with serial sectioning [22]
TIC is convenient, timesaving, low cost, and the procedure is relatively simple with no loss of specimen; TIC is prone to atypical results because of fewer cells and no complete organizational structure [25,26,27]
Summary
As the most common malignant disease and the second leading cause of cancer mortality in women, breast carcinoma poses a threat to women’s health [1, 2]. Sentinel lymph node (SLN) biopsies have become the standard for predicting overall axillary status in clinically node-negative breast cancer patients [3, 4]. Patients with pathologically-negative SLNs may safely avoid further axillary lymph node dissection (ALND), reducing complications, such as lymphedema, pain, upper limb movement disorders, and decreased quality of life [5,6,7]. The intra-operative detection of SLNs has become a decisive factor in whether or not to proceed with ALND. How to effectively utilize TIC to reduce intra-operative misdiagnosis of SLNs and allow patients to safely avoid a second surgical procedure has become the focus of attention for surgeons
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
