Accuracy of intraoperative imprint cytology for sentinel lymph node evaluation in the treatment of breast carcinoma: A 6-year study

Charles Cox, Barbara Centeno, Dan Dickson, John Clark, Santo Nicosia, Elisabeth Dupont, Harvey Greenberg, Nicholas Stowell, Laura White, Jayesh Patel, Ben Furman, Alan Cantor, Ardeshir Hakam, Nazeel Ahmad, Nils Diaz, Jeff King

Research output: Contribution to journalReview article

56 Citations (Scopus)

Abstract

BACKGROUND. The current report provides results from a large retrospective analysis of intraoperative imprint cytology performed on axillary sentinel lymph nodes (IICN) removed over the course of 2137 breast surgeries (4905 lymph nodes). It is hoped that these results may serve as benchmarks for those interested in using this technique. METHODS. The current study included 2078 patients with T1-2 invasive breast carcinoma who underwent sentinel lymph node biopsy (SLNB) and IICN. Lymph nodes were bivalved, imprinted, stained with Diff-Quik (Baxter Diagnostics, McGaw Park, IL), and reviewed by a cytopathologist. A positive intraoperative diagnosis led to immediate complete axillary lymph node dissection (CALND). On final pathology, lymph nodes found to be negative on hematoxylin and eosin staining were submitted for cytokeratin staining. RESULTS. Of the 2137 cases for which SLNB was performed, 673 were found to have positive lymph node status on final pathology. Of these 673 cases, 359 were identified by IICN, resulting in a sensitivity rate of 53.3%. The specificity and overall accuracy rates for this technique were 99.5% and 85.0%, respectively. In IDC cases, IICN had a sensitivity rate of 55.5%, compared with 38.7% in ILC cases. Based on these results, the reoperative CALND rate was calculated to be approximately 14.7%, with 54.5% of these reoperative procedures being performed for cases in which lymph nodes positive only for micrometastases were found. Macrometastasis-positive lymph nodes that went undetected by IICN were present in only 154 of the 2137 cases examined (7.2%). CONCLUSIONS. IICN accurately predicts final lymph node status in 85.0% of patients. Although the accuracy of this technique varies with tumor size and type, IICN remains a time-efficient and cost-effective adjunct to SLNB.

Original languageEnglish (US)
Pages (from-to)13-20
Number of pages8
JournalCancer
Volume105
Issue number1
DOIs
StatePublished - Feb 25 2005

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Cell Biology
Lymph Nodes
Breast Neoplasms
Sentinel Lymph Node Biopsy
Lymph Node Excision
Therapeutics
Pathology
Staining and Labeling
Benchmarking
Neoplasm Micrometastasis
Hematoxylin
Eosine Yellowish-(YS)
Keratins
Sentinel Lymph Node
Breast
Costs and Cost Analysis
Neoplasms

Keywords

  • Breast carcinoma surgery
  • Cytopathology
  • Imprint cytology
  • Micrometastasis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Accuracy of intraoperative imprint cytology for sentinel lymph node evaluation in the treatment of breast carcinoma : A 6-year study. / Cox, Charles; Centeno, Barbara; Dickson, Dan; Clark, John; Nicosia, Santo; Dupont, Elisabeth; Greenberg, Harvey; Stowell, Nicholas; White, Laura; Patel, Jayesh; Furman, Ben; Cantor, Alan; Hakam, Ardeshir; Ahmad, Nazeel; Diaz, Nils; King, Jeff.

In: Cancer, Vol. 105, No. 1, 25.02.2005, p. 13-20.

Research output: Contribution to journalReview article

Cox, C, Centeno, B, Dickson, D, Clark, J, Nicosia, S, Dupont, E, Greenberg, H, Stowell, N, White, L, Patel, J, Furman, B, Cantor, A, Hakam, A, Ahmad, N, Diaz, N & King, J 2005, 'Accuracy of intraoperative imprint cytology for sentinel lymph node evaluation in the treatment of breast carcinoma: A 6-year study', Cancer, vol. 105, no. 1, pp. 13-20. https://doi.org/10.1002/cncr.20738
Cox, Charles ; Centeno, Barbara ; Dickson, Dan ; Clark, John ; Nicosia, Santo ; Dupont, Elisabeth ; Greenberg, Harvey ; Stowell, Nicholas ; White, Laura ; Patel, Jayesh ; Furman, Ben ; Cantor, Alan ; Hakam, Ardeshir ; Ahmad, Nazeel ; Diaz, Nils ; King, Jeff. / Accuracy of intraoperative imprint cytology for sentinel lymph node evaluation in the treatment of breast carcinoma : A 6-year study. In: Cancer. 2005 ; Vol. 105, No. 1. pp. 13-20.
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abstract = "BACKGROUND. The current report provides results from a large retrospective analysis of intraoperative imprint cytology performed on axillary sentinel lymph nodes (IICN) removed over the course of 2137 breast surgeries (4905 lymph nodes). It is hoped that these results may serve as benchmarks for those interested in using this technique. METHODS. The current study included 2078 patients with T1-2 invasive breast carcinoma who underwent sentinel lymph node biopsy (SLNB) and IICN. Lymph nodes were bivalved, imprinted, stained with Diff-Quik (Baxter Diagnostics, McGaw Park, IL), and reviewed by a cytopathologist. A positive intraoperative diagnosis led to immediate complete axillary lymph node dissection (CALND). On final pathology, lymph nodes found to be negative on hematoxylin and eosin staining were submitted for cytokeratin staining. RESULTS. Of the 2137 cases for which SLNB was performed, 673 were found to have positive lymph node status on final pathology. Of these 673 cases, 359 were identified by IICN, resulting in a sensitivity rate of 53.3{\%}. The specificity and overall accuracy rates for this technique were 99.5{\%} and 85.0{\%}, respectively. In IDC cases, IICN had a sensitivity rate of 55.5{\%}, compared with 38.7{\%} in ILC cases. Based on these results, the reoperative CALND rate was calculated to be approximately 14.7{\%}, with 54.5{\%} of these reoperative procedures being performed for cases in which lymph nodes positive only for micrometastases were found. Macrometastasis-positive lymph nodes that went undetected by IICN were present in only 154 of the 2137 cases examined (7.2{\%}). CONCLUSIONS. IICN accurately predicts final lymph node status in 85.0{\%} of patients. Although the accuracy of this technique varies with tumor size and type, IICN remains a time-efficient and cost-effective adjunct to SLNB.",
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author = "Charles Cox and Barbara Centeno and Dan Dickson and John Clark and Santo Nicosia and Elisabeth Dupont and Harvey Greenberg and Nicholas Stowell and Laura White and Jayesh Patel and Ben Furman and Alan Cantor and Ardeshir Hakam and Nazeel Ahmad and Nils Diaz and Jeff King",
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T1 - Accuracy of intraoperative imprint cytology for sentinel lymph node evaluation in the treatment of breast carcinoma

T2 - A 6-year study

AU - Cox, Charles

AU - Centeno, Barbara

AU - Dickson, Dan

AU - Clark, John

AU - Nicosia, Santo

AU - Dupont, Elisabeth

AU - Greenberg, Harvey

AU - Stowell, Nicholas

AU - White, Laura

AU - Patel, Jayesh

AU - Furman, Ben

AU - Cantor, Alan

AU - Hakam, Ardeshir

AU - Ahmad, Nazeel

AU - Diaz, Nils

AU - King, Jeff

PY - 2005/2/25

Y1 - 2005/2/25

N2 - BACKGROUND. The current report provides results from a large retrospective analysis of intraoperative imprint cytology performed on axillary sentinel lymph nodes (IICN) removed over the course of 2137 breast surgeries (4905 lymph nodes). It is hoped that these results may serve as benchmarks for those interested in using this technique. METHODS. The current study included 2078 patients with T1-2 invasive breast carcinoma who underwent sentinel lymph node biopsy (SLNB) and IICN. Lymph nodes were bivalved, imprinted, stained with Diff-Quik (Baxter Diagnostics, McGaw Park, IL), and reviewed by a cytopathologist. A positive intraoperative diagnosis led to immediate complete axillary lymph node dissection (CALND). On final pathology, lymph nodes found to be negative on hematoxylin and eosin staining were submitted for cytokeratin staining. RESULTS. Of the 2137 cases for which SLNB was performed, 673 were found to have positive lymph node status on final pathology. Of these 673 cases, 359 were identified by IICN, resulting in a sensitivity rate of 53.3%. The specificity and overall accuracy rates for this technique were 99.5% and 85.0%, respectively. In IDC cases, IICN had a sensitivity rate of 55.5%, compared with 38.7% in ILC cases. Based on these results, the reoperative CALND rate was calculated to be approximately 14.7%, with 54.5% of these reoperative procedures being performed for cases in which lymph nodes positive only for micrometastases were found. Macrometastasis-positive lymph nodes that went undetected by IICN were present in only 154 of the 2137 cases examined (7.2%). CONCLUSIONS. IICN accurately predicts final lymph node status in 85.0% of patients. Although the accuracy of this technique varies with tumor size and type, IICN remains a time-efficient and cost-effective adjunct to SLNB.

AB - BACKGROUND. The current report provides results from a large retrospective analysis of intraoperative imprint cytology performed on axillary sentinel lymph nodes (IICN) removed over the course of 2137 breast surgeries (4905 lymph nodes). It is hoped that these results may serve as benchmarks for those interested in using this technique. METHODS. The current study included 2078 patients with T1-2 invasive breast carcinoma who underwent sentinel lymph node biopsy (SLNB) and IICN. Lymph nodes were bivalved, imprinted, stained with Diff-Quik (Baxter Diagnostics, McGaw Park, IL), and reviewed by a cytopathologist. A positive intraoperative diagnosis led to immediate complete axillary lymph node dissection (CALND). On final pathology, lymph nodes found to be negative on hematoxylin and eosin staining were submitted for cytokeratin staining. RESULTS. Of the 2137 cases for which SLNB was performed, 673 were found to have positive lymph node status on final pathology. Of these 673 cases, 359 were identified by IICN, resulting in a sensitivity rate of 53.3%. The specificity and overall accuracy rates for this technique were 99.5% and 85.0%, respectively. In IDC cases, IICN had a sensitivity rate of 55.5%, compared with 38.7% in ILC cases. Based on these results, the reoperative CALND rate was calculated to be approximately 14.7%, with 54.5% of these reoperative procedures being performed for cases in which lymph nodes positive only for micrometastases were found. Macrometastasis-positive lymph nodes that went undetected by IICN were present in only 154 of the 2137 cases examined (7.2%). CONCLUSIONS. IICN accurately predicts final lymph node status in 85.0% of patients. Although the accuracy of this technique varies with tumor size and type, IICN remains a time-efficient and cost-effective adjunct to SLNB.

KW - Breast carcinoma surgery

KW - Cytopathology

KW - Imprint cytology

KW - Micrometastasis

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