Usefulness of intraoperative touch smear cytology in breast-conserving surgery.

Abstract

Abstract Abstract #3011 [Objective] In the treatment of breast-conserving surgery, positive margins are closely related to intramammary recurrence, but methods of assessing resection stumps during breast-conserving surgery have not been standardized. The present study investigated the usefulness of intraoperative touch smear cytology at our department.
 [Subjects and Methods] From 2005 to 2007, a total of 308 patients underwent breast cancer surgery. Subjects comprised 160 patients who underwent breast-conserving surgery and touch smear cytology. Results of touch smear cytology were compared to those of histological tissue analysis.
 [Results] Touch smear cytology displayed 70% sensitivity (14/20), 97.1% specificity (136/140) and a diagnostic accuracy of 93.8% (150/160). Six false-negative cases and 4 false-positive cases were identified. Of the 6 false-negatives, cancer cells were seen in the mammary duct in 5 cases, and the degree of cancer cell atypia in the stump was low. Residual cancer cells were seen in the stump in 18 cases, and additional resection was performed on 16 cases. Cancer cells were identified histologically in the additionally resected tissue in 8 of these 16 cases (50.0%). The direction of positive cytology was towards the mammary papilla in 16 cases, lateral tissue in 5 cases and contralateral mammary papilla in 2 cases. The tendency was that that the greater the cancer cell volume as assessed by touch smear cytology, the higher the frequency of positive margins as assessed by histological tissue analysis.
 [Discussion] Histological tissue analysis and touch smear cytology can be performed to assess resection stumps during breast-conserving surgery. Histological tissue analysis is accurate, but: 1) analyzing all areas of a large resection stump is difficult; 2) preparing high-quality frozen sections is difficult due to the high adipose content of breast tissue; 3) assessing the malignancy of intraductal proliferating lesions is difficult; and 4) part of the tissue sample is damaged. Touch smear cytology is easy to perform, offering a very useful technique yielding comparable results to histological tissue analysis. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3011.