Is Intraoperative Imprint Cytology Evaluation Still Feasible for the Evaluation of Sentinel Lymph Nodes for Lobular Carcinoma of the Breast?
Identifieur interne : 004E03 ( Main/Exploration ); précédent : 004E02; suivant : 004E04Is Intraoperative Imprint Cytology Evaluation Still Feasible for the Evaluation of Sentinel Lymph Nodes for Lobular Carcinoma of the Breast?
Auteurs : Marissa Howard-Mcnatt [États-Unis] ; Kim R. Geisinger [États-Unis] ; John H. Stewart [États-Unis] ; Perry Shen [États-Unis] ; Edward A. Levine [États-Unis]Source :
- Annals of surgical oncology [ 1068-9265 ] ; 2011.
Abstract
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.
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.
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%;
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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DOI: 10.1245/s10434-011-2038-z
PubMed: 21879268
PubMed Central: 3733474
Affiliations:
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Geisinger</name><affiliation wicri:level="2"><nlm:aff id="A2">Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, NC</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Caroline du Nord</region></placeName><wicri:cityArea>Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem</wicri:cityArea></affiliation></author><author><name sortKey="Stewart, John H" sort="Stewart, John H" uniqKey="Stewart J" first="John H." last="Stewart">John H. Stewart</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Surgical Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Caroline du Nord</region></placeName><wicri:cityArea>Department of Surgical Oncology, Wake Forest Baptist Medical Center, Winston-Salem</wicri:cityArea></affiliation></author><author><name sortKey="Shen, Perry" sort="Shen, Perry" uniqKey="Shen P" first="Perry" last="Shen">Perry Shen</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Surgical Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Caroline du Nord</region></placeName><wicri:cityArea>Department of Surgical Oncology, Wake Forest Baptist Medical Center, Winston-Salem</wicri:cityArea></affiliation></author><author><name sortKey="Levine, Edward A" sort="Levine, Edward A" uniqKey="Levine E" first="Edward A." last="Levine">Edward A. Levine</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Surgical Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Caroline du Nord</region></placeName><wicri:cityArea>Department of Surgical Oncology, Wake Forest Baptist Medical Center, Winston-Salem</wicri:cityArea></affiliation></author></analytic><series><title level="j">Annals of surgical oncology</title><idno type="ISSN">1068-9265</idno><idno type="eISSN">1534-4681</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title><p id="P1">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.</p></sec><sec id="S2"><title>Methods</title><p id="P2">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.</p></sec><sec id="S3"><title>Results</title><p id="P3">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%; <italic>P</italic> = .09) and sensitivity (52% vs 71%; <italic>P</italic> = .02) has improved since 2004.</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">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.</p></sec></div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Caroline du Nord</li></region></list><tree><country name="États-Unis"><region name="Caroline du Nord"><name sortKey="Howard Mcnatt, Marissa" sort="Howard Mcnatt, Marissa" uniqKey="Howard Mcnatt M" first="Marissa" last="Howard-Mcnatt">Marissa Howard-Mcnatt</name></region><name sortKey="Geisinger, Kim R" sort="Geisinger, Kim R" uniqKey="Geisinger K" first="Kim R." last="Geisinger">Kim R. Geisinger</name><name sortKey="Levine, Edward A" sort="Levine, Edward A" uniqKey="Levine E" first="Edward A." last="Levine">Edward A. Levine</name><name sortKey="Shen, Perry" sort="Shen, Perry" uniqKey="Shen P" first="Perry" last="Shen">Perry Shen</name><name sortKey="Stewart, John H" sort="Stewart, John H" uniqKey="Stewart J" first="John H." last="Stewart">John H. 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