Abstract
OBJECTIVES:To compare imprint cytology and paraffin section histology for sentinel lymph node detection in women with breast cancer treated with neoadjuvant chemotherapy.METHOD:A cross-sectional study and report of the sentinel lymph node statuses of 64 patients with breast cancer who underwent intraoperative imprint cytology and neoadjuvant chemotherapy in a referral cancer institute in Rio de Janeiro, Brazil, between 2014 and 2016.RESULTS:The mean age was 51 years. The most common histological type was invasive ductal carcinoma (93.75%), and the most common differentiation grade was 2 (62.5%). Overall, 153 lymph nodes were identified, with a mean of 2.39/case. Thirty-four lymph nodes tested positive for malignancy by imprint cytology, and 55 tested positive by histology. Of the 55 positive lymph nodes, 41 (74.5%) involved macrometastases, and 14 (25.5%) involved micrometastases. There were 21 false negatives with imprint cytology, namely, 7 for macrometastases and 14 for micrometastases, resulting in a rate of 17.6%. The sensitivity of imprint cytology was 61.8%, with a specificity and positive predictive value of 100%, a negative predictive value of 82.4% and an accuracy of 86.3%. The method presented null sensitivity for the identification of micrometastases.CONCLUSIONS:The false-negative rate with imprint cytology was associated with the number of sentinel lymph nodes obtained. The rate found for complete response to neoadjuvant chemotherapy was comparable to the rates reported in the literature. The accuracy of imprint cytology was good, and its specificity was excellent for sentinel lymph node detection; however, the method was unable to detect lymph node micrometastases.
Highlights
Breast cancer is the most prevalent cancer type in Brazilian women
Immunohistochemistry revealed that 14% of the cases were triple-negative, 15.6% were human epidermal growth factor receptor 2 (HER2)-positive, and 73% were estrogen receptor (ER)-positive
51.5% of the cases were classified as T2, namely, between 2 and 5 cm, 35.9% were classified as T3, and 12.5% were classified as T1
Summary
According to the National Cancer Institute (INCA), 57,960 new cases are expected for the 2016-2017 period [1]. Axillary staging is a key step in the treatment of breast cancer. Axillary dissection was the standard method used in most cases, being considered an important factor in predicting recurrence and survival [2]. In Brazil, more extensive surgeries and axillary dissections are often used, these procedures are associated with the occurrence of both short- and long-term complications, the most common being hemorrhage, infection, seroma, upper.
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