Touch Imprint Research Articles

Role of imprint cytology in the intraoperative diagnosis of pituitary adenomas

The cytologic touch imprint alone can be diagnostic of pituitary adenomas and meningiomas, etc. A 45-year-old man was operated upon for intracranial meningioma. Imprint cytology revealed distinct cytologic features which helped arriving at the specific diagnosis of pituitary adenoma intraoperatively. Subsequent histopathology and immuno-histochemistry confirmed the diagnosis. Thus intraoperative touch preparations are of immense help in arriving at a diagnosis as well as in excluding other possible differential diagnoses and therefore can replace frozen section for intraoperative consultations of sellar and parasellar tumors.

Intraoperative evaluation of sentinel lymph nodes in breast cancer: comparison of frozen sections, imprint cytology and immunocytochemistry

We analysed the utility of imprint cytology with rapid immunocytochemistry and frozen section analysis for the evaluation of sentinel lymph nodes in breast cancer patients. The sensitivity, specificity, and positive and negative predictive values have been calculated for each method individually, each pair and all three together. We compared these results with those of routinely processed paraffin sections. The sensitivity and specificity of each of the three methods for detection of metastatic carcinoma were as follows: 69.4% and 97.8% for touch imprint cytology; 58.3% and 100% for frozen sections; 68.5% and 98.9% for rapid immunocytochemistry. When the methods were combined, the highest accuracy was achieved by touch imprint cytology, frozen sections, touch imprint cytology plus rapid immunocytochemistry, or touch imprint cytology frozen section analysis and rapid immunocytochemistry, each of these having identical sensitivity and specificity of 72.2% and 97.8%, respectively. In our study the combined accuracy of the three methods was the same as combining touch imprint cytology and frozen sections or touch imprint cytology plus rapid immunocytochemistry. Rapid immunocytochemistry provides an additional parameter and preserves tissue for permanent sections.

Increase of core biopsies in visceral organs–experience at one institution

All targeted core biopsies in the surgical pathology file and all cytology specimens from liver, lung, kidney, and pancreas accessioned in 1997, 2002, and 2007 in the Pathology Department at the Beth Israel Deaconess Medical Center, Boston, were culled. Cytology specimen type [touch imprint smear (TIS) from core-only, fine-needle aspiration (FNA)-only, or both] was determined. Seven hundred and fifty-eight targeted core biopsies were identified from the years 1997 (162), 2002 (249), and 2007 (347). Eight hundred and seventy-eight cytology specimens from the years 1997 (127), 2002 (264), and 2007 (487) were included. The overall percentage of TIS-only of all cytology specimens increased from 5.5 to 31% in 10 years and most prominently in the liver (14% in 1997 to 87% in 2007). In spite of the increasing use of core biopsies, the volume of cytology specimens from these organs increased from 127 in 1997 to 487 in 2007.

Sensitivity and specificity of Pre-Operative Axillary Ultrasound Scanning and Touch Imprint Cytology of Sentinel Lymph Nodes in a District Hospital Practice

Sensitivity and specificity of Pre-Operative Axillary Ultrasound Scanning and Touch Imprint Cytology of Sentinel Lymph Nodes in a District Hospital Practice

Bone marrow metastasis by solid tumors—probable hematological indicators and comparison of bone marrow aspirate, touch imprint and trephine biopsy

Bone marrow metastasis is an important presentation of solid tumors affecting their prognosis and management. The present study was conducted to analyze the hematological indicators which can predict the marrow metastasis along with the comparison of bone marrow aspirate, touch imprint and trephine biopsy, to define an effective method for its early diagnosis. The study showed that there was statistical significant difference in mean of mean platelet volume (MPV) and platelet distribution width (PDW) between the cases and controls (P<0·001) and MPV at cut off of <8 fl showed significantly high positive predictive value (100%) and likelihood ratio (21·170) for bone marrow metastasis. Furthermore, bone marrow imprint cytology detected metastatic cells in 96% of cases. Thus, the study concluded that low MPV could be used as a probable indicator for bone marrow metastasis and the meticulously prepared touch imprint smears, along with bone marrow aspirate, provide an efficient method for rapid diagnosis of metastasis.

Can touch imprint cytology replace fine needle aspiration within current clinical practice?

To investigate whether touch imprint cytology (TIC) of needle core biopsy (NCB) is as effective as fine needle aspiration cytology (FNAC) for providing same-day diagnosis of benign and malignant breast lesions at our one-stop symptomatic breast clinic.

Fine needle aspiration versus touch imprint cytology in ultrasound-guided core of breast masses

The aim of this study was to compare the results of fine needle aspiration (FNAC, current practice) with imprint cytology (CIC) from ultrasound-guided cores taken in the one-stop clinic setting. CIC allows same-day results with one biopsy procedure. Literature suggests CIC provides a higher sensitivity/C5 rate, although there are few direct comparisons of CIC with FNAC.

Intraoperative touch imprint cytology of axillary sentinel nodes for breast cancer: A series of 355 procedures

Aims Our objective was to evaluate intraoperative sentinel node touch imprint cytology (IOSNTI) for breast cancer. Three hundred and fifty-five patients with invasive breast cancer (pT1 N0, lobular or ductal subtype) were included in our study. IOSNTI consists of touching glass slides to the surfaces of interest after gently pressing the spatially localized specimen, taken according to predetermined conditions, in order to perform a final histological examination consisting of H&E and immunohistochemical staining. Results The total sensitivity (Se) of IOSNTI was 36% and 15% of patients with nodal metastasis went undetected during the intraoperative examination. Sensitivity was significantly lower for the oldest patients (aged over 57 years: 25%), small tumors (smaller than 12 mm: 23.3%), lobular subtypes (8.3%), in the absence of vascular emboli (33%) and for detection of micrometastases (10%). Discussion This simple, fast and relatively inexpensive method could be combined with intraoperative molecular biology methods in populations in which cytology is less efficient and produces negative results.

Scanning elastic scattering spectroscopy detects metastatic breast cancer in sentinel lymph nodes

A novel method for rapidly detecting metastatic breast cancer within excised sentinel lymph node(s) of the axilla is presented. Elastic scattering spectroscopy (ESS) is a point-contact technique that collects broadband optical spectra sensitive to absorption and scattering within the tissue. A statistical discrimination algorithm was generated from a training set of nearly 3000 clinical spectra and used to test clinical spectra collected from an independent set of nodes. Freshly excised nodes were bivalved and mounted under a fiber-optic plate. Stepper motors raster-scanned a fiber-optic probe over the plate to interrogate the node's cut surface, creating a 20x20 grid of spectra. These spectra were analyzed to create a map of cancer risk across the node surface. Rules were developed to convert these maps to a prediction for the presence of cancer in the node. Using these analyses, a leave-one-out cross-validation to optimize discrimination parameters on 128 scanned nodes gave a sensitivity of 69% for detection of clinically relevant metastases (71% for macrometastases) and a specificity of 96%, comparable to literature results for touch imprint cytology, a standard technique for intraoperative diagnosis. ESS has the advantage of not requiring a pathologist to review the tissue sample.

The Evaluation and Optimization of Intraoperative Touch Imprint Cytology for Sentinel Lymph Nodes in Early‐stage Breast Cancer in China

Accurate intraoperative diagnosis of sentinel lymph node (SLN) metastasis reduces the need for additional surgery in patients with involved nodes. The present study evaluates the clinical value of multiple cross-sectional touch imprint cytology (TIC) as an intraoperative assessment for the diagnosis of SLN metastasis. This study consisted of 366 patients with surgically harvested SLNs that were sliced along their long axis at 2.0-3.0-mm intervals and 122 patients with SLNs that were sliced along their short axis at 1.5-mm intervals using a cutting apparatus designed by our group. The first group of patients was enrolled in this study between February 2005 and February 2008, while the second group was enrolled between March 2008 and January 2009. Serial sectioning of the SLNs at 100-microm intervals with hematoxylin-eosin (H&E) staining was used as the gold standard for pathological diagnosis. Multiple cross-sectional TIC has a sensitivity, specificity, and overall accuracy rate of 92.0, 99.0, and 97.5%, respectively, on a per-patient basis, and it is superior to the standard imprint preparation protocol. Furthermore, the multiple cross-sectional TIC technique developed in this study was observed to detect more accurately macrometastases on a per-patient basis in comparison to the typical protocol (P = 0.023). Of the patients included in this study, 97.7% had a positive SLN within their first three harvested SLNs. Multiple cross-sectional TIC is superior to the standard protocol, especially due to its ability to locate macrometastasis. Limiting intraoperative TIC to the first three harvested SLNs in the diagnosis of SLN metastasis may make this diagnostic procedure significantly cheaper and easier for pathologists to perform.

Hemophagocytic Lymphohistiocytosis in B-Cell Lymphoproliferative Disorder: Report of a Rare Association

Hemophagocytic Lymphohistiocytosis in B-Cell Lymphoproliferative Disorder: Report of a Rare Association

Influence of imaging on touch imprint cytology of breast lesions

Purpose: Touch imprint cytology (TIC) facilitates rapid diagnosis of breast diseases in women attending triple assessment clinics. Some pathologists, in our centre, feel that pathological interpretation of TIC slides is contentious when the lesions are radiologically indeterminate (R3), as these can lead to potentially higher false positive or false negative cytology results. We hypothesised that: ‘(R3) lesions are more likely to have higher false positive or false negative TIC and/or be inadequate for TIC assessment’. In other words, ‘imaging influences cytological classification especially when indeterminate’. Methods: Review of the data collected in our centre between December 2003 and July 2005. All patients who attended the one stop symptomatic breast clinic and had a TIC performed following an ultrasound (US) guided core biopsy (CB) were included. Demographic, radiological, cytological and core biopsy grading data were collected. Cytology grading was correlated with radiology classification to assess our hypothesis. Results: A total of 248 patients underwent 254 CB/TIC. The average patient's age of the group was 54 years (range of 29–95). On TIC, 186 (73%) were deemed malignant, 23(9%) benign while 33(13%) were inadequate for assessment. There was no false positive or false negative TIC. There was good correlation between TIC and CB results ( p < 0.0001). Thirty-three cases were inadequate (C1) for cytology assessment, of these16 (48.5%) were indeterminate on imaging. R3 lesions were 6 times more prone to have C1 cytology ( p < 0.0001). Conclusion: Touch imprint cytology is a reliable and efficient method in running a one stop breast clinic, with the backup of full tissue diagnosis. Careful selection of cases that would benefit from this technique is highly recommended as a significant number of radiologically indeterminate lesions are likely to be insufficient for cytological assessment. Further prospective trials are required to assess this further. Until then the diagnosis in this sub-group should depend on core biopsy.

Comparison of a novel molecular assay with touch imprint and permanent histology of sentinel lymph nodes in early-stage breast cancer.

642 Background: Current intraoperative assay of the sentinel lymph nodes (SLN) either by touch imprint or frozen section has high false-negative rates. We aimed to study validity of a novel reverse transcriptase-polymerase chain reaction (RT-PCR) assay compared to intraoperative touch preps as well as final histology. Methods: Pts with BrCa underwent SLN Mapping (M). Alternate slices of the SLNs were examined for mammoglobin and cytokeratin 19 (CK19) by RT-PCR assay, with the remainder of the SLNs processed and evaluated pathologically with four H&E and one CK immunostain. Results: Seventy-eight pts were studies. Nine (11.5%) DCIS, 57 (73.1%) T1, 11 (14.1%) T2 and 1 (1.3%) had T3 tumor. Overall nodal metastasis was 25% with 4 pts having positive micrometastasis (0.2-2 mm). In the included 69 pts (excluding DCIS), sensitivity of RT-PCR was 81.3% compared to 50% for touch prep. RT-PCR carried a negative predictive value of 94.5% (52/55 pts) compared to 86.8% (53/61) with touch preps. RT-PCR identified one p...

Preclinical evaluation of nuclear morphometry and tissue topology for breast carcinoma detection and margin assessment

Prevention and early detection of breast cancer are the major prophylactic measures taken to reduce the breast cancer related mortality and morbidity. Clinical management of breast cancer largely relies on the efficacy of the breast-conserving surgeries and the subsequent radiation therapy. A key problem that limits the success of these surgeries is the lack of accurate, real-time knowledge about the positive tumor margins in the surgically excised tumors in the operating room. This leads to tumor recurrence and, hence, the need for repeated surgeries. Current intraoperative techniques such as frozen section pathology or touch imprint cytology severely suffer from poor sampling and non-optimal detection sensitivity. Even though histopathology analysis can provide information on positive tumor margins post-operatively (~2-3 days), this information is of no immediate utility in the operating rooms. In this article, we propose a novel image analysis method for tumor margin assessment based on nuclear morphometry and tissue topology and demonstrate its high sensitivity/specificity in preclinical animal model of breast carcinoma. The method relies on imaging nuclear-specific fluorescence in the excised surgical specimen and on extracting nuclear morphometric parameters (size, number, and area fraction) from the spatial distribution of the observed fluorescence in the tissue. We also report the utility of tissue topology in tumor margin assessment by measuring the fractal dimension in the same set of images. By a systematic analysis of multiple breast tissues specimens, we show here that the proposed method is not only accurate (~97% sensitivity and 96% specificity) in thin sections, but also in three-dimensional (3D) thick tissues that mimic the realistic lumpectomy specimens. Our data clearly precludes the utility of nuclear size as a reliable diagnostic criterion for tumor margin assessment. On the other hand, nuclear area fraction addresses this issue very effectively since it is a combination of both nuclear size and count in any given region of the analyzed image, and thus yields high sensitivity and specificity (~97%) in tumor detection. This is further substantiated by an independent parameter, fractal dimension, based on the tissue topology. Although the basic definition of cancer as an uncontrolled cell growth entails a high nuclear density in tumor regions, a simple but systematic exploration of nuclear distribution in thick tissues by nuclear morphometry and tissue topology as performed in this study has never been carried out, to the best of our knowledge. We discuss the practical aspects of implementing this imaging approach in automated tissue sampling scenario where the accuracy of tumor margin assessment can be significantly increased by scanning the entire surgical specimen rather than sampling only a few sections as in current histopathology analysis.

Establishing axillary Sentinel Lymph Node Biopsy (SLNB) for early breast cancer in the United Kingdom: A survey of the national training program

Introduction The UK National training programme (NEWSTART) for SLNB in breast cancer was established in 2004, aimed at providing structured, standardised training with a focus on multidisciplinary team (MDT) delivery. Methodology A questionnaire was devised and after approval by the Association of Breast Surgeons (ABS) executive committee they were sent to all full members of the ABS. Results Most (97%) of breast surgeons are convinced by the evidence for SLNB as standard of care for early breast cancer. 64% use SLNB to stage clinically node negative patients, of whom 23% use it as a standalone procedure. 38% of surgeons were dissatisfied with the time it takes to complete the in house training, and 87% with the time it takes to complete the validation phase. Logistical and funding issues were the main problems cited. The majority of surgeons (86%) use the recommended combined technique, with 47% continuing to use the dual localisation method. 14% use either blue dye or isotope alone, without scintiscan. Only 10% offer intra operative diagnosis, of which the majority (6%) use touch imprint cytology. 31% included their results in their most recent surgical appraisal. Conclusions The majority of breast surgeons in the UK are convinced by the evidence for SLNB, and most use SLNB in their practice for staging. Reasons for not conducting SLNB are logistical rather than lack of belief in the procedure. The majority of respondents completed their training within the anticipated time line. The majority of centres do not perform intra-operative assessment.

Intraoperative Touch Imprint and Frozen Section Analysis of Sentinel Lymph Nodes After Neoadjuvant Chemotherapy for Breast Cancer

To evaluate the accuracy of touch imprint and frozen section analysis of sentinel nodes after neoadjuvant chemotherapy. Intraoperative evaluation of the sentinel node can determine the need for axillary dissection at the time of initial operation and therefore spare the patient a second operation. Little data, however, exists on the accuracy of intraoperative evaluation of sentinel nodes after neoadjuvant chemotherapy. A retrospective chart review was performed of all sentinel node procedures for breast cancer from 2004 to 2008 at a single institution. The sentinel node procedure was done before (no-NACT) chemotherapy in 107 patients and 37 had the procedure after neoadjuvant (NACT) chemotherapy. Intraoperative analysis of sentinel nodes was performed using touch imprint and frozen section techniques. In the no-NACT group, intraoperative assessment by touch imprint analysis had 61% sensitivity, 100% specificity, and 87% accuracy. Frozen section analysis was similar with 74% sensitivity, 100% specificity, and 90% accuracy. In the NACT group, touch imprint analysis had 79% sensitivity, 100% specificity, and 90% accuracy. Frozen section analysis was again similar with 74% sensitivity, 100% specificity, and 83% accuracy. When the no-NACT group and the NACT group were compared, both frozen section and touch imprint analysis had similar sensitivity, specificity, and accuracy. Intraoperative evaluation of sentinel nodes with touch imprint and frozen section analysis in patients treated with neoadjuvant chemotherapy showed acceptable sensitivity, specificity, and accuracy. Nearly all of the misses in intraoperative evaluation were in patients with micrometastases.

Touch Imprint Cytology of Axillary Lymph Nodes in a District General Hospital Setting: A Feasibility Study

Touch Imprint Cytology of Axillary Lymph Nodes in a District General Hospital Setting: A Feasibility Study

Is There an Association Between Radon Exposure and the Incidence of Thyroid Cancer?

Is There an Association Between Radon Exposure and the Incidence of Thyroid Cancer?

Significance of biological resource collection and tumor tissue bank creation

Progress in the molecular oncology of gastrointestinal carcinomas depends on high quality cancer tissues for research. Recent acceleration on new technological platforms as well as the "omics" revolution increases the demands on tissues and peripheral blood for research at the DNA, mRNA and protein levels. Tissue bank creation emerges as a priority. Tumor tissue banks are facilities that are organized to collect, store and distribute samples of tumor and normal tissue for further use in basic and translational cancer research. The samples are generally obtained immediately after excision, prior to fixation, to ensure optimal preservation of proteins and nucleic acids. It is possible for surgeons or pathologists to collect fresh tissue prospectively during their routine dissection procedures. Most tissue banks are "project-driven" tumor banks, which are specialized collections of tumor samples on which their research is based. Systematic collection of all available tumor tissue is much rarer. High quality tissue banks need the collaboration of clinicians and basic scientists, but also the informed consent of patients and ethical approval. Through the standard operation procedure, snap frozen fresh tissue collection, storage and quality control for cryopreserved tissues are the pivotal factors on tissue bank construction and maintaining. The purpose of the tissue bank creation is enhancing the quality and speed on both the basic and translational research on gastrointestinal cancer. The quality assurance and quality control are handled based on reviewing HE staining slides or touch imprint cytology by pathologists.

The Influence of Touch-Imprint Cytology on Further Management for Breast Cancer Patients

The Influence of Touch-Imprint Cytology on Further Management for Breast Cancer Patients