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Elshanbary AA, Awad AA, Abdelsalam A, Ibrahim IH, Abdel-Aziz W, Darwish YB, Isa AS, Drid B, Mustafa MG, Allam RH, Abo Ali AA, Nourelden AZ, Ragab KM, AlGwaiz HIM, Awaji AA, Germoush MO, Albrakati A, Piscopo M, Ghaboura N, Zaazouee MS. The diagnostic accuracy of intraoperative frozen section biopsy for diagnosis of sentinel lymph node metastasis in breast cancer patients: a meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:47931-47941. [PMID: 35543788 PMCID: PMC9252966 DOI: 10.1007/s11356-022-20569-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Sentinel lymph node (SLN) sampling is important for evaluating the nodal stage of breast cancer when the axillary nodes are clinically free of metastasis. The intraoperative frozen section (IFS) of SLN is used for lymph node assessment. This meta-analysis aims to provide evidence about the diagnostic accuracy and the applicability of IFS of SLN in breast cancer patients. Data were collected by searching PubMed, Cochrane, Scopus, and Web of Science electronic databases for trials matching our eligibility criteria. The statistical analysis included the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and pooled studies' diagnostic odds ratio outcomes. The analyses were conducted using the Open Meta-analyst software. This meta-analysis pooled the results of 110 studies. The overall sensitivity of IFS for SLN metastasis was 74.7%; 95% CI [72.0, 77.2], P < 0.001. It was 31.4% 95% CI [25.2, 38.3], P < 0.001 for the micro-metastasis, and 90.2%; 95% CI [86.5, 93.0], P < 0.001 for the macro-metastasis. The overall specificity was 99.4%; 95% CI [99.2, 99.6], P < 0.001. The overall positive likelihood ratio was 121.4; 95% CI [87.9, 167.6], P < 0.001, and the overall negative likelihood ratio was 0.226; 95% CI [0.186, 0.274], P < 0.001. The overall diagnostic odds ratio of IFS for diagnosing SLN metastasis was 569.5; 95% CI [404.2, 802.4], P < 0.001. The intraoperative frozen section of SLN has good sensitivity for diagnosing breast cancer macro-metastasis. However, the sensitivity is low for micro-metastasis. The specificity is very satisfactory.
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Affiliation(s)
- Alaa Ahmed Elshanbary
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Alaa Abdelsameia Awad
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Alaa Abdelsalam
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Islam H Ibrahim
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Walid Abdel-Aziz
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Youssef Bahaaeldin Darwish
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Alaa Saad Isa
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Boutheyna Drid
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Batna 2 University, Batna, Algeria
| | - Marwa Gamal Mustafa
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Pharmacy, Fayoum University, Fayoum, Egypt
| | - Radwa Hamdy Allam
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Amira A Abo Ali
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Anas Zakarya Nourelden
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Khaled Mohamed Ragab
- International Medical Research Association (IMedRA), Cairo, Egypt
- Faculty of Medicine, Minia University, Minia, Egypt
| | - Hussah I M AlGwaiz
- Department of Biology, College of Science, Princess Nourah Bint Abdulrahman University, Riyadh, 11474, Saudi Arabia
| | - Aeshah A Awaji
- Department of Biology, Faculty of Science, University College of Taymaa, University of Tabuk, Tabuk, 71491, Saudi Arabia
| | - Mousa O Germoush
- Biology Department, College of Science, Jouf University, P.O. Box: 2014, Sakaka, Saudi Arabia
| | - Ashraf Albrakati
- Department of Human Anatomy, College of Medicine, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
| | - Marina Piscopo
- Department of Biology, University of Naples Federico II, Via Cinthia, 80126, Naples, Italy
| | - Nehmat Ghaboura
- Department of Pharmacy Practice, Batterjee Medical College, Pharmacy Program, P.O. Box 6231, Jeddah, 21442, Saudi Arabia
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Is Real-Time Microscopy on the Horizon? A Brief Review of the Potential Future Directions in Clinical Breast Tumor Microscopy Implementation. Virchows Arch 2022; 480:211-227. [PMID: 35218378 DOI: 10.1007/s00428-022-03300-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/16/2022] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
Abstract
We will briefly review the current paradigm and some recent developments in the area of clinical breast microscopy, highlighting several promising commercially available, and research-based platforms. Confocal microscopy (reflectance, fluorescence, and spectrally encoded), optical coherence tomography (wide field and full field), stereomicroscopy, open-top light sheet microscopy, microscopy with ultraviolet surface excitation, nonlinear microscopy, Raman scattering microscopy, photoacoustic microscopy, and needle microendoscopy will be discussed. Non-microscopic methods for breast pathology assessment are beyond the scope of this review. These microscopic technologies have to varying degrees the potential for transforming breast cancer care, but in order for any of these to be integrated into clinical practice there are several hurdles to overcome. In our review we will focus on what needs to be done in order for the commercially available technologies to become more established, what the technologies in the research domain need to do in order to reach the commercial realm; and finally, what the field of breast pathology might look like if these technologies were to be widely adopted.
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Cotarelo CL, Zschöck-Manus A, Schmidt M, Schad A, Brochhausen C, Kirkpatrick CJ, Thaler S. Improved detection of sentinel lymph node metastases allows reliable intraoperative identification of patients with extended axillary lymph node involvement in early breast cancer. Clin Exp Metastasis 2020; 38:61-72. [PMID: 33249518 PMCID: PMC7882580 DOI: 10.1007/s10585-020-10065-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 11/15/2020] [Indexed: 12/14/2022]
Abstract
An improved procedure that allows accurate detection of negative sentinel lymph node (SLN) and of SLN macrometastases during surgery would be highly desirable in order to protect patients from further surgery and to avoid unnecessary costs. We evaluated the accuracy of an intraoperative procedure that combines touch imprint cytology (TIC) and subsequent frozen section (FS) analysis. 2276 SLNs from 1072 patients with clinical node-negative early breast cancer were evaluated during surgery using TIC. Only cytologically-positive SLN were subsequently analysed with a single FS, preserving cytologically-negative SLN for the final postoperative histological diagnosis. Sensitivity, specificity and the accuracy of this approach were analysed by comparing the results from intra- and postoperative SLN and axillary node evaluation. This intraoperative method displayed 100% specificity for SLN metastases and was significantly more sensitive for prognostically relevant macrometastases (85%) than for micrometastases (10%). Sensitivity was highest for patients with two or more positive LNs (96%) than for those with only one (72%). 98% of the patients with final pN2a-pN3a were already identified during surgery. Patients who received primary axillary lymph node dissection had significantly more frequent metastases in further LNs (44.6%). Sensitivity was highest for patients with luminal-B, HER2+ and triple negative breast cancer and for any subtype if Ki-67 > 40%. TIC and subsequent FS of cytologically-positive SLNs is highly reliable for detection of SLN macrometastases, and allows accurate identification of patients with a high risk of extended axillary involvement during surgery, as well as accurate histological diagnosis of negative SLN.
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Affiliation(s)
- Cristina L Cotarelo
- Institute of Pathology, Heinrich Heine University and University Hospital of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany.
| | - Annemarie Zschöck-Manus
- Institute of Pathology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Marcus Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Arno Schad
- Institute of Pathology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | | | | | - Sonja Thaler
- European Centre for Angioscience (ECAS), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Pathmanathan N, Renthawa J, French JR, Edstrom-Elder E, Hall G, Mahajan H, Teh C, Bilous MA. Intraoperative sentinel lymph node assessment in breast cancer: a comparison of rapid diagnostic method based on CK19 mRNA expression and imprint cytology. ANZ J Surg 2014; 84:730-4. [PMID: 24899463 DOI: 10.1111/ans.12668] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Sentinel lymph node biopsy in breast cancer is a routine technique for staging the axilla. The two most common methods of intraoperative histopathological assessment, imprint cytology and frozen section, are hampered by poor sensitivity and lack standardized methodology. The one-step nuclei acid amplification (OSNA) assay is a rapid quantification of cytokeratin 19 mRNA. This prospective study compared an existing intraoperative imprint cytology protocol with the OSNA system. METHODS Of the 110 prospectively recruited patients, 98 met the inclusion criteria with a total of 170 lymph nodes. Intraoperative sentinel nodes were serially sectioned and imprints made of each cut surface for cytological assessment. Alternate slices were submitted for OSNA while the remaining slices were for final histopathological evaluation with six hematoxylin and eosin levels and one AE1/AE3 immunoperoxidase stain of each slice. RESULTS On histopathological analysis, 24.5% of patients (16.5% of nodes) had sentinel node metastases and 3.1% (2.4%) had isolated tumour cells. With isolated tumour cells cases taken as negative, the sensitivity of imprint cytology and OSNA compared with histopathology were 66.7% on patient basis (71.4% on per-node basis) and 95.8% (89.3%), respectively. One of 22 patients with macrometastases and two of three micrometastases were designated negative while five false-positive nodes were identified with OSNA, likely due to tissue allocation bias. CONCLUSION The OSNA assay is highly sensitive in comparison with imprint cytology and may be used effectively in the intraoperative setting. Clinical follow-up studies are warranted to further assess its use in routine practice.
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Affiliation(s)
- Nirmala Pathmanathan
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia; Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Madsen EVE, van Dalen J, van Gorp J, van Oort PMP, van Dalen T. Frozen section analysis of sentinel lymph nodes in patients with breast cancer does not impair the probability to detect lymph node metastases. Virchows Arch 2011; 460:69-76. [PMID: 22116209 PMCID: PMC3267028 DOI: 10.1007/s00428-011-1171-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 09/28/2011] [Accepted: 11/04/2011] [Indexed: 11/29/2022]
Abstract
Intra-operative frozen section analysis (FS analysis) of sentinel lymph nodes (SLNs) in patients with breast cancer can prevent a second operation for axillary lymph node dissection. In contrast, loss of tissue during FS analysis may impair the probability to detect lymph node metastases. To determine the effect of tissue loss on the probability of detection of metastases, dimensions and tissue loss resulting from intra-operative frozen section analysis were measured for 21 SLNs. In a mathematical model, the influence of tissue loss on the probability to detect metastases was calculated in relation to SLN size for various pathology protocols: an American, a widely used European, the extensive ‘Milan’ and the Dutch protocol. For median-sized SLN 11 × 8 × 5 mm (length × width × height), FS analysis led to a median loss of 680 μm (13.6%) of the height of the SLN. Irrespective of SLN size or used pathology protocol, the probability of detecting 2 mm metastases remained unchanged or even increased (0–12.8%). Moreover, the probability to detect 0.2 mm metastases increased for the majority of tested combinations of SLN size, tissue loss and used protocol. Only when combining maximum tissue loss and smallest SLN size in the Dutch protocol, or when applying the extensive Milan protocol on a median-sized SLN, the probability to detect 0.2 mm metastases decreased by 2.7% and 14.3%, respectively. Contrary to ‘common knowledge’, doing FS analysis of SLNs does not impair the probability to detect lymph node metastases.
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Affiliation(s)
- Eva V E Madsen
- Department of Surgery, Diakonessenhuis, Bosboomstraat 1, Utrecht, The Netherlands.
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Godey F, Leveque J, Tas P, Gandon G, Poree P, Mesbah H, Lavoue V, Quillien V, Athias CB. Sentinel lymph node analysis in breast cancer: contribution of one-step nucleic acid amplification (OSNA). Breast Cancer Res Treat 2011; 131:509-16. [PMID: 21993859 DOI: 10.1007/s10549-011-1808-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 09/26/2011] [Indexed: 11/27/2022]
Abstract
One-step nucleic acid amplification (OSNA, Sysmex, Kobe, Japan) offers an excellent opportunity for accurate exhaustive sentinel lymph node (SLN) examination in breast cancer patients. Calibrated with conventional postoperative histology, this molecular technique yields comparable results intraoperatively, expressed as micrometastasis, macrometastasis or no metastasis depending on the CK19 mRNA copy number amplified in SLN lysates. We applied OSNA to detect metastasis in 810 SLNs from 367 patients with early stage breast cancer. We compared the rate of OSNA-positive SLNs in patients with invasive breast cancer (< 2 cm) versus the rate observed in a historical cohort using conventional histological examination of SLNs. No significant difference was observed, the OSNA assay was positive in 24.4% of patients, compared with positive histology in 24.8% in the historical cohort if including patients with isolated tumour cell (ITC) and in 23.4% excluding them. Opportunities for optimised patient management using OSNA are discussed: intraoperative detection of OSNA-positive SLNs enables axillary lymph node dissection (ALND) during the same procedure; standard OSNA techniques enable the establishment of homogeneous groups based on examination of whole SLNs for valid comparisons between different centres.
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Affiliation(s)
- Florence Godey
- Regional Mastology Center, Departement of Biology, Eugène Marquis Comprehensive Cancer Center, CS 44 229, Avenue de Bataille Flandres Dunkerques, 35 042 Rennes Cedex, France.
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