Accuracy of intraoperative imprint cytology of sentinel lymph nodes in breast cancer

Pugliese, Matthew S.; Kohr, Jennifer R.; Allison, Kimberly H.; Wang, Nan Ping; Tickman, Ronald J.; Beatty, J. David

doi:10.1016/j.amjsurg.2006.05.014

« Previous Next »The American Journal of Surgery
Volume 192, Issue 4 , Pages 516-519, October 2006

Accuracy of intraoperative imprint cytology of sentinel lymph nodes in breast cancer

Presented at the 7th Annual Meeting of the American Society of Breast Surgeons, Baltimore, Maryland, April 5–9, 2006

Matthew S. Pugliese, M.D.
- Department of Surgery, Comprehensive Breast Cancer Program, Swedish Cancer Institute, Seattle, WA, USA
Jennifer R. Kohr, M.D.
- Department of Surgery, Comprehensive Breast Cancer Program, Swedish Cancer Institute, Seattle, WA, USA
Kimberly H. Allison, M.D.
- Department of Anatomic Pathology, University of Washington Medical Center, 1959 NE Pacific, Seattle, WA 98122, USA
Nan Ping Wang, M.D., Ph.D.
- Department of Pathology, Comprehensive Breast Cancer Program, Swedish Cancer Institute, Seattle, WA, USA
Ronald J. Tickman, M.D.
- Department of Pathology, Comprehensive Breast Cancer Program, Swedish Cancer Institute, Seattle, WA, USA
J. David Beatty, M.D.
- Department of Surgery, Comprehensive Breast Cancer Program, Swedish Cancer Institute, Seattle, WA, USA
- Corresponding author. Tel.: +1-206-215-6410; fax: +1-206-215-6401.

Received 5 April 2006; received in revised form 31 May 2006

Abstract

Background

In breast cancer treatment, immediate completion of axillary lymph node dissection (ALND) can be performed if the intraoperative sentinel lymph node (SLN) examination is positive. This study evaluates the accuracy of intraoperative imprint cytology (IC) for detecting SLN metastases.

Methods

Pathology reports from 385 SLN biopsy examinations were reviewed retrospectively. The SLNs were serially sectioned perpendicular to the long axis and IC was performed intraoperatively. The SLNs then were formalin-fixed for permanent sections. Final pathology was compared with the intraoperative IC results.

Results

The sensitivities for IC detection of N0(i+) (n = 36), N1mi (n = 24), and N1a-3a (n = 65) metastases were 0%, 4%, and 74%, respectively. The specificity was 100%.

Conclusions

Final pathology identified 89 (23%) patients with N1 or greater disease. IC allowed 49 (55%) of these patients to undergo synchronous completion of ALND. No unnecessary completion ALNDs were performed. The sensitivity of IC decreased with decreasing size of the metastasis.

Keywords: Imprint cytology , Touch preparation , Sentinel lymph node , Sentinel lymph node biopsy , Breast cancer