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Accuracy of Imprint Cytology for Intraoperative Diagnosis of Sentinel Node Metastases in Breast Cancer

Motomura, Kazuyoshi MD, PhD*; Nagumo, Sachiko CT†; Komoike, Yoshifumi MD, PhD*; Koyama, Hiroki MD, PhD*; Inaji, Hideo MD, PhD*

Annals of Surgery:
doi: 10.1097/SLA.0b013e3181675855
Original Articles
Abstract

Objective: The aim of this study was to determine the accuracy of imprint cytology for the intraoperative diagnosis of sentinel node metastases in patients with breast cancer.

Summary Background Data: Accurate intraoperative diagnosis of sentinel node metastases enables the selection of patients who need axillary lymph node dissection during the same operation.

Methods: This study included 631 patients with clinical T1 breast cancer with clinically negative nodes. Sentinel nodes were serially sectioned at 2-mm intervals. Imprint cytologic samples were made from all cut surfaces and stained with Papanicolaou staining. Patients with positive sentinel nodes underwent immediate axillary lymph node dissection. Those with negative sentinel nodes diagnosed by intraoperative imprint cytology, but positive by final pathologic results, underwent subsequent axillary lymph node dissection. The results of imprint cytology were compared with the final pathologic results using hematoxylin and eosin staining and immunohistochemistry.

Results: In 110 of 130 patients with positive sentinel nodes diagnosed by final pathology, imprint cytology of at least one sentinel node was positive. In 17 of 501 patients with tumor-negative sentinel nodes diagnosed by final pathology, imprint cytology of at least one sentinel node was positive. The sensitivity, specificity, and overall accuracy of imprint cytology for the diagnosis of sentinel node metastases were 84.6%, 96.6%, and 94.1%, respectively. Only 20 (3.2%) patients required a second axillary operation in the present study.

Conclusion: Intraoperative imprint cytology is a useful method for evaluating sentinel node metastasis in patients with breast cancer.

In Brief

Accurate intraoperative diagnosis of sentinel node metastases enables the selection of patients who need axillary lymph node dissection during the same operation. We demonstrated in this study that intraoperative imprint cytology is a useful method for evaluating sentinel node metastasis in patients with breast cancer.

Author Information

From the Departments of *Surgery, and †Cytology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, Japan.

Reprints: Kazuyoshi Motomura, MD, Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan. E-mail: motomurak@hotmail.com.

© 2008 Lippincott Williams & Wilkins, Inc.