Testing the Feasibility of Intra-Operative Sentinel Lymph Node Touch Imprint Cytology
Identifieur interne : 006007 ( Main/Exploration ); précédent : 006006; suivant : 006008Testing the Feasibility of Intra-Operative Sentinel Lymph Node Touch Imprint Cytology
Auteurs : Alireza Hamidian Jahromi [Royaume-Uni] ; Sankaran Narayanan [Royaume-Uni] ; Fiona Macneill [Royaume-Uni] ; Peter Osin [Royaume-Uni] ; Ashutash Nerurkar [Royaume-Uni] ; Gerald Gui [Royaume-Uni]Source :
- Annals of The Royal College of Surgeons of England [ 0035-8843 ] ; 2009.
Abstract
Sentinel lymph node biopsy is emerging as the new standard for axillary staging in breast cancer. Intra-operative assessment of the sentinel lymph nodes allows immediate completion of axillary dissection during the same anaesthetic. This project was a quality assurance practice to establish feasibility, time-to-report, as well as accuracy of performing intra-operative assessment of sentinel lymph nodes using touch imprint cytology in our centre.
This prospective audit included 146 sentinel lymph nodes from 74 consecutive patients with invasive breast cancer. All patients underwent axillary sentinel lymph node biopsy using combined blue dye and radiocolloid technique. Results of intra-operative touch imprint cytology using haematoxylin and eosin staining were compared with the definitive histopathology results.
Mean time to report touch imprint cytology was 25.7 ± 6.4 min (range, 15–40 min). Histopathology demonstrated metastasis in 25 sentinel nodes from 17 (23%) patients. Intra-operative touch imprint cytology detected 15 nodes in 11 patients, giving a sensitivity of 60% (nodes) and 66.7% (patients) and specificity of 99.2% (nodes) and 98.2% (patients) based on the number of nodes and patients involved, respectively. Touch imprint cytology failed to show metastatic involvement in 10 nodes from 6 patients; of these, five nodes had micrometastasis (< 2 mm) and the other five had macrometastasis. One touch imprint cytology positive node contained isolated tumour cells only. Using intra-operative touch imprint cytology made a change in treatment of 11(14.9%) patients, and spared second axillary procedure in 7 (9.4%) patients.
Intra-operative sentinel lymph node assessment using touch imprint cytology is feasible within a busy NHS practice. We now offer touch imprint cytology to patients following appropriate counselling.
Url:
DOI: 10.1308/003588409X391758a
PubMed: 19344553
PubMed Central: 2749406
Affiliations:
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type="wicri:Area/Main/Exploration">006007</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Testing the Feasibility of Intra-Operative Sentinel Lymph Node Touch Imprint Cytology</title><author><name sortKey="Jahromi, Alireza Hamidian" sort="Jahromi, Alireza Hamidian" uniqKey="Jahromi A" first="Alireza Hamidian" last="Jahromi">Alireza Hamidian Jahromi</name><affiliation wicri:level="1"><nlm:aff id="au1"><institution>Renal Transplant Department, St George' Hospital</institution><addr-line>London, UK</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London</wicri:regionArea></affiliation></author><author><name sortKey="Narayanan, Sankaran" sort="Narayanan, Sankaran" uniqKey="Narayanan S" first="Sankaran" last="Narayanan">Sankaran Narayanan</name><affiliation wicri:level="1"><nlm:aff id="au2"><institution>Departments of Breast Surgery, The Royal Marsden NHS Foundation Trust</institution><addr-line>London, UK</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London</wicri:regionArea></affiliation></author><author><name sortKey="Macneill, Fiona" sort="Macneill, Fiona" uniqKey="Macneill F" first="Fiona" last="Macneill">Fiona Macneill</name><affiliation wicri:level="1"><nlm:aff id="au2"><institution>Departments of Breast Surgery, The Royal Marsden NHS Foundation Trust</institution><addr-line>London, UK</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London</wicri:regionArea></affiliation></author><author><name sortKey="Osin, Peter" sort="Osin, Peter" uniqKey="Osin P" first="Peter" last="Osin">Peter Osin</name><affiliation wicri:level="1"><nlm:aff id="au3"><institution>Departments of Histopathology, The Royal Marsden NHS Foundation Trust</institution><addr-line>London, UK</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London</wicri:regionArea></affiliation></author><author><name sortKey="Nerurkar, Ashutash" sort="Nerurkar, Ashutash" uniqKey="Nerurkar A" first="Ashutash" last="Nerurkar">Ashutash Nerurkar</name><affiliation wicri:level="1"><nlm:aff id="au3"><institution>Departments of Histopathology, The Royal Marsden NHS Foundation Trust</institution><addr-line>London, UK</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London</wicri:regionArea></affiliation></author><author><name sortKey="Gui, Gerald" sort="Gui, Gerald" uniqKey="Gui G" first="Gerald" last="Gui">Gerald Gui</name><affiliation wicri:level="1"><nlm:aff id="au2"><institution>Departments of Breast Surgery, The Royal Marsden NHS Foundation Trust</institution><addr-line>London, UK</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London</wicri:regionArea></affiliation></author></analytic><series><title level="j">Annals of The Royal College of Surgeons of England</title><idno type="ISSN">0035-8843</idno><idno type="eISSN">1478-7083</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>INTRODUCTION</title><p>Sentinel lymph node biopsy is emerging as the new standard for axillary staging in breast cancer. Intra-operative assessment of the sentinel lymph nodes allows immediate completion of axillary dissection during the same anaesthetic. This project was a quality assurance practice to establish feasibility, time-to-report, as well as accuracy of performing intra-operative assessment of sentinel lymph nodes using touch imprint cytology in our centre.</p></sec><sec><title>PATIENTS AND METHODS</title><p>This prospective audit included 146 sentinel lymph nodes from 74 consecutive patients with invasive breast cancer. All patients underwent axillary sentinel lymph node biopsy using combined blue dye and radiocolloid technique. Results of intra-operative touch imprint cytology using haematoxylin and eosin staining were compared with the definitive histopathology results.</p></sec><sec><title>RESULTS</title><p>Mean time to report touch imprint cytology was 25.7 ± 6.4 min (range, 15–40 min). Histopathology demonstrated metastasis in 25 sentinel nodes from 17 (23%) patients. Intra-operative touch imprint cytology detected 15 nodes in 11 patients, giving a sensitivity of 60% (nodes) and 66.7% (patients) and specificity of 99.2% (nodes) and 98.2% (patients) based on the number of nodes and patients involved, respectively. Touch imprint cytology failed to show metastatic involvement in 10 nodes from 6 patients; of these, five nodes had micrometastasis (< 2 mm) and the other five had macrometastasis. One touch imprint cytology positive node contained isolated tumour cells only. Using intra-operative touch imprint cytology made a change in treatment of 11(14.9%) patients, and spared second axillary procedure in 7 (9.4%) patients.</p></sec><sec><title>CONCLUSIONS</title><p>Intra-operative sentinel lymph node assessment using touch imprint cytology is feasible within a busy NHS practice. We now offer touch imprint cytology to patients following appropriate counselling.</p></sec></div></front></TEI><affiliations><list><country><li>Royaume-Uni</li></country></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Jahromi, Alireza Hamidian" sort="Jahromi, Alireza Hamidian" uniqKey="Jahromi A" first="Alireza Hamidian" last="Jahromi">Alireza Hamidian Jahromi</name></noRegion><name sortKey="Gui, Gerald" sort="Gui, Gerald" uniqKey="Gui G" first="Gerald" last="Gui">Gerald Gui</name><name sortKey="Macneill, Fiona" sort="Macneill, Fiona" uniqKey="Macneill F" first="Fiona" last="Macneill">Fiona Macneill</name><name sortKey="Narayanan, Sankaran" sort="Narayanan, Sankaran" uniqKey="Narayanan S" first="Sankaran" last="Narayanan">Sankaran Narayanan</name><name sortKey="Nerurkar, Ashutash" sort="Nerurkar, Ashutash" uniqKey="Nerurkar A" first="Ashutash" last="Nerurkar">Ashutash Nerurkar</name><name sortKey="Osin, Peter" sort="Osin, Peter" uniqKey="Osin P" first="Peter" last="Osin">Peter Osin</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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