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A Systematic Review and Meta-analysis of Touch Imprint Cytology and Frozen Section Biopsy and Their Comparison for Evaluation of Sentinel Lymph Node in Breast Cancer. World J Surg 2023; 47:478-488. [PMID: 36310323 DOI: 10.1007/s00268-022-06800-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Evaluation of axillary lymph nodes after sentinel lymph node biopsy (SLNB) in breast cancer is mostly done by intra-operative frozen section biopsy (FSB) and/ or touch imprint cytology (TIC). In this systematic review and meta-analysis, we have compared the accuracy of the two modalities. METHODS PubMed, EMBASE, and Cochrane electronic databases were searched for articles comparing TIC with FSB. Articles were assessed for methodological and reporting quality. The main summary measures were pooled sensitivity, pooled specificity, and diagnostic accuracy using bivariate generalized linear mixed models using random effects. RESULTS Fourteen studies were included. The pooled sensitivity, specificity, and diagnostic accuracy for FSB were 78%, 100%, and 98.57%. For TIC, the pooled sensitivity, specificity, and diagnostic accuracy were 74%, 98%, and 98.37%. For both methods, visual inspection of summary ROC curves and of forest plots did not show significant heterogeneity. CONCLUSION TIC showed comparable sensitivity, specificity, and accuracy to FSB and hence can be used as its substitute as a rapid and economical test for the detection of axillary lymph node metastasis during SLNB especially in low-resource settings.
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Mohammadnia Avval M, Hosseinzadeh M, Farahi Z, Mirtalebi M. Comparing scraping cytology with touch imprint cytology and frozen section analysis in the intraoperative diagnosis of sentinel lymph node metastasis in breast cancer. Diagn Cytopathol 2021; 49:475-479. [PMID: 33405395 DOI: 10.1002/dc.24695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 12/17/2020] [Accepted: 12/29/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Breast cancer is a common cancer in the female population. Sentinel lymph node (SLN) in breast cancer patients can be evaluated by different methods including intraoperative frozen section analysis (FSA), touch imprint cytology (TIC), and scraping cytology (SC). In this study, in addition to investigating TIC and FSA, we focused on SC to evaluate the diagnostic value of this almost new method. MATERIALS AND METHODS In this retrospective study, the quadrantectomy and sentinel lymph node resection of 150 specimens with mammography and core needle biopsy-confirmed breast cancer were examined. Of the 150 participants, 77 and 73 had negative and positive results for the permanent pathology of SLN metastasis, respectively. Intra-operative FSA, TIC, and SC for SLN were performed for the patients and all were confirmed by permanent pathology. RESULTS All the specimens were taken from females aged between 25 and 82 years. The sensitivity and specificity of TIC, FS, and SC were 73% and 50%, 92.6% and 50%, and 92.1% and 50%, respectively. Among the three techniques, TIC had the lowest positive and negative predictive values. However, FS had the highest positive predictive value whereas SC had the highest negative predictive value. CONCLUSION In addition to FS and TIC as rapid, cost-effective, and reliable diagnostic methods in SLN metastasis, SC is an acceptable and highly sensitive method. A combination of these methods may provide a more favorable diagnostic value for SLN assessment in breast cancer patients.
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Affiliation(s)
| | | | - Zahra Farahi
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
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Sun L, Chen G, Zhou Y, Zhang L, Jin Z, Liu W, Wu G, Jin F, Li K, Chen B. Clinical significance of MSKCC nomogram on guiding the application of touch imprint cytology and frozen section in intraoperative assessment of breast sentinel lymph nodes. Oncotarget 2017; 8:78105-78112. [PMID: 29100452 PMCID: PMC5652841 DOI: 10.18632/oncotarget.17490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/07/2017] [Indexed: 11/25/2022] Open
Abstract
The widely practiced intra-operative methods for rapid evaluation and detection of sentinel lymph node (SLN) status include frozen section (FS) and touch imprint cytology (TIC). This study optimized the use of TIC and FS in the intra-operative detection of breast SLNs based on the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram. Three hundred forty-two SLNs were removed from 79 patients. SLN metastatic probability was assessed by the MSKCC nomogram. The SLNs underwent intra-operative TIC and FS, as well as routine post-operative paraffin sections (RPSs). The relationships between TIC, FS, and SLN metastatic probability were analyzed. Overall, TIC was more sensitive than FS (92.31% vs. 76.92%), while TIC specificity was inferior to FS specificity (84.85% vs. 100%). In addition, the best cut-off value for TIC based on the MSKCC nomogram was inferior to the best FS cut-off value (22.5% vs. 34.5%). All patients with a MSKCC value <22.5% in the present study were negative based on FS and RPS, while the true-negative and false-positive rates for TIC were 92.5% and 7.5%, respectively. Thus, early breast cancer patients, based on a MSKCC value <22.5%, can safely avoid FS, but should have TIC performed intra-operatively. Patients with a MSKCC value >22.5% should have TIC and FS to determine the size of metastases, whether or not to proceed with axillary lymph node dissection, and to avoid easily missed metastases.
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Affiliation(s)
- Lisha Sun
- Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Guanglei Chen
- Department of Breast Disease and Reconstruction Center, Breast Cancer Key Laboratory of Dalian, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yizhen Zhou
- Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Lei Zhang
- Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Zining Jin
- Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Weiguang Liu
- Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Guangping Wu
- Department of Pathology, The First Hospital of China Medical University, Shenyang, China
| | - Feng Jin
- Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Kai Li
- Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Bo Chen
- Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China
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Horváth Z, Paszt A, Simonka Z, Látos M, Oláh V, Nagyszegi D, Kaizer L, Fejes Z, Hamar S, Csörgő E, Ormándi K, Lázár M, Lázár G. Is intraoperative touch imprint cytology indicated in the surgical treatment of early breast cancers? Eur J Surg Oncol 2017; 43:1252-1257. [PMID: 28139361 DOI: 10.1016/j.ejso.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 11/29/2016] [Accepted: 01/10/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Intraoperative touch imprint cytology (TIC) of the sentinel lymph node(s) (SLN(s)) in the treatment of breast cancer has significantly reduced the number of axillary block dissections (ABD) required during second surgeries. Based on recent studies, ABD was not considered necessary if the presence of tumor cells/micrometastasis was confirmed in the SLN(s) or in the case of macrometastases in a patient group meeting the inclusion criteria for the ACOSOG Z0011 study. Our aim was to determine the sensitivity and usefulness of TIC with regard to these results. METHODS TICs of the SLN(s) were examined in 1168 patients operated on for breast cancer. The method was also analyzed retrospectively based on the guidelines for the Z0011 study. During TIC, new samples were cut every 250 μm; impression smears were evaluated after being stained with hematoxylin eosin. RESULTS TIC confirmed metastasis in 202 cases (202/1168, 17.29%). Metastasis was confirmed in SLN(s) in 149 additional cases during a final histological examination. The sensitivity of TIC was found to be 57.18%, and its specificity was 99.63%. An analysis was then performed except for cases that met the inclusion criteria for the Z0011 study and with metastasis smaller than 2 mm (micrometastasis/isolated tumor cells) considered to be positive during intraoperative cytology. The sensitivity of the method decreased to 34.23%, while its specificity was still high at 99.76%. CONCLUSIONS Based on the new guidelines for ABD, imprint cytology cannot be considered a beneficial and cost-effective intervention in the surgical treatment of early breast cancer.
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Affiliation(s)
- Z Horváth
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary.
| | - A Paszt
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary.
| | - Z Simonka
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary.
| | - M Látos
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary.
| | - V Oláh
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary.
| | - D Nagyszegi
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary.
| | - L Kaizer
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Center, Allomás u. 2., Szeged, H-6720, Hungary.
| | - Z Fejes
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Center, Allomás u. 2., Szeged, H-6720, Hungary.
| | - S Hamar
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Center, Allomás u. 2., Szeged, H-6720, Hungary.
| | - E Csörgő
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Center, Allomás u. 2., Szeged, H-6720, Hungary.
| | - K Ormándi
- Diagnoscan Hungary - Szeged, Semmelweis u. 6., Szeged, H-6725, Hungary.
| | - M Lázár
- Diagnoscan Hungary - Szeged, Semmelweis u. 6., Szeged, H-6725, Hungary.
| | - G Lázár
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Center, Semmelweis u. 8., Szeged, H-6720, Hungary.
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Saha M, Mukherjee R, Chakraborty C. Computer-aided diagnosis of breast cancer using cytological images: A systematic review. Tissue Cell 2016; 48:461-74. [DOI: 10.1016/j.tice.2016.07.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/16/2016] [Accepted: 07/27/2016] [Indexed: 12/13/2022]
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Classe JM, Baffert S, Sigal-Zafrani B, Fall M, Rousseau C, Alran S, Rouanet P, Belichard C, Mignotte H, Ferron G, Marchal F, Giard S, Tunon de Lara C, Le Bouedec G, Cuisenier J, Werner R, Raoust I, Rodier JF, Laki F, Colombo PE, Lasry S, Faure C, Charitansky H, Olivier JB, Chauvet MP, Bussières E, Gimbergues P, Flipo B, Houvenaeghel G, Dravet F, Livartowski A. Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients 'on behalf of the Group of Surgeons from the French Unicancer Federation'. Ann Oncol 2012; 23:1170-1177. [PMID: 21896543 PMCID: PMC3335244 DOI: 10.1093/annonc/mdr355] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 05/11/2011] [Accepted: 06/20/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients. PATIENTS AND METHODS We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery. RESULTS Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€ 2947 (σ = 580) versus € 3331 (σ = 902); P = 0.0001]. CONCLUSION ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.
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Affiliation(s)
- J M Classe
- Surgical Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes.
| | - S Baffert
- Medico economic unit, Institut Curie, Paris
| | | | - M Fall
- Medico economic unit, Institut Curie, Paris
| | - C Rousseau
- Nuclear medicine Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes
| | - S Alran
- Surgical Department, Institut Curie, Paris
| | - P Rouanet
- Surgical Department, Center Val d'Aurel Montpellier
| | - C Belichard
- Surgical Department, Center René Huguenin, Saint Cloud
| | - H Mignotte
- Surgical Department, Center Léon Bérard, Lyon
| | - G Ferron
- Surgical Department, Institut Claudius Regaud, Toulouse
| | - F Marchal
- Surgical Department, Center Alexis Vautrin, Nancy
| | - S Giard
- Surgical Department, Center Oscar Lambret, Lille
| | | | - G Le Bouedec
- Surgical Department, Center Jean Perrin, Clermont Ferrand
| | - J Cuisenier
- Surgical Department, Center Georges François Leclerc, Dijon
| | - R Werner
- Surgical Department, Center Jean Godinot, Reims
| | - I Raoust
- Surgical Department, Center Georges Lacassagne, Nice
| | - J-F Rodier
- Surgical Department, Center Paul Strauss, Strasbourg
| | - F Laki
- Medico economic unit, Institut Curie, Paris; Surgical Department, Institut Curie, Paris
| | - P-E Colombo
- Surgical Department, Center Val d'Aurel Montpellier
| | - S Lasry
- Surgical Department, Center René Huguenin, Saint Cloud
| | - C Faure
- Surgical Department, Center Léon Bérard, Lyon
| | - H Charitansky
- Surgical Department, Institut Claudius Regaud, Toulouse
| | - J-B Olivier
- Surgical Department, Center Alexis Vautrin, Nancy
| | - M-P Chauvet
- Surgical Department, Center Oscar Lambret, Lille
| | - E Bussières
- Surgical Department, Center Bergonié, Bordeaux
| | - P Gimbergues
- Surgical Department, Center Jean Perrin, Clermont Ferrand
| | - B Flipo
- Surgical Department, Center Georges Lacassagne, Nice
| | - G Houvenaeghel
- Surgical Department, Institut Paoli Calmette Marseille, France
| | - F Dravet
- Surgical Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes
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Howard-McNatt M, Geisinger KR, Stewart JH, Shen P, Levine EA. Is intraoperative imprint cytology evaluation still feasible for the evaluation of sentinel lymph nodes for lobular carcinoma of the breast? Ann Surg Oncol 2011; 19:929-34. [PMID: 21879268 DOI: 10.1245/s10434-011-2038-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND The evaluation of sentinel lymph nodes (SLNs) from a patient with lobular breast cancer is challenging. Metastatic lobular cancer is difficult to identify in SLNs because of its low-grade cytomorphology and its tendency to resemble lymphocytes. Intraoperative imprint cytology (IIC) is a rapid, reliable method for evaluating SLNs intraoperatively. We sought to reexamine our experience with this technique in the identification of invasive lobular breast cancer SLN metastases. METHODS A retrospective review of a prospectively maintained database of IIC results of 1010 SLN mapping procedures for breast cancer was performed. From this cohort we reviewed SLN cases of lobular cancer. The SLNs were evaluated intraoperatively by bisecting the SLN. Imprints were made of each cut surface and stained with hematoxylin and eosin (H&E) and Diff-Quik. Permanent sections were evaluated with up to 4 H&E-stained levels and cytokeratin immunohistochemistry. IIC results were compared with final pathologic results. RESULTS A total of 67 cases of pure invasive lobular cancer were identified. The sensitivity was 71%, specificity was 100%, and accuracy was 92%. No statistically significant differences in sensitivity, specificity, or accuracy were identified between the intraoperative detection of lobular carcinoma vs ductal carcinoma. The specificity has remained the same since 2004. However the accuracy (82% vs 92%; P = .09) and sensitivity (52% vs 71%; P = .02) has improved since 2004. CONCLUSIONS As we have previously shown, the sensitivity and specificity of IIC in evaluating lobular carcinoma is feasible and accurate. IIC continues to be a viable alternative to frozen section for intraoperative evaluation.
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Affiliation(s)
- Marissa Howard-McNatt
- Department of Surgical Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Factor R, Layfield LJ. Intraprocedural evaluation of fine-needle aspiration smears: How good are we? Diagn Cytopathol 2011; 40:760-3. [DOI: 10.1002/dc.21618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 11/13/2010] [Indexed: 11/07/2022]
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