A Comparative Study between Intraoperative Scrape Imprint Immunocytochemistry and Serial Section with Combined H&E Staining and Immunohistochemistry for the Detection of Breast Cancer Cell Metastasis in the Sentinel Lymph Node
Keywords:
sentinel lymph node, immunocytochemistry, breast cancerAbstract
Background: The multidisciplinary approach for the improvement of the accuracy of sentinel lymph node (SN) examination is beneficial as it is a less invasive procedure for breast cancer patients. The trend in avoiding axillary dissection will decrease the operative morbidity. The intraoperative technique for the detection of tumor cells in SN by imprint immunocytochemistry (ICC) was studied to avoid axillary dissection.
Objective: The aim of this study was to compare the results of intraoperative scrape imprint ICC with the results of serial section stained by combined hematoxylin-eosin (H&E) and subsequent immunohistochemistry (IHC). The accuracy, sensitivity and specificity of both methods were analysed.
Material and Methods: From April 2005 to March 2006, 33 patients with breast cancer were enrolled. The sentinel lymph nodes were removed and sent to pathologists for scrape imprint cytology. The anticytokeratin ICC was used to detect metastatic cancer cells. The sentinel lymph nodes were then routinely examined by H&E staining. If the cancer cells were not detected by the routine H&E study, the negative nodes were then serially sectioned at 20 µm and stained by anticytokeratin IHC to rule out the false negative results. The axillary contents of all cases were removed following the SN dissection for complete pathologic examination to confirm the SN node examination results.
Results: Seventy-two sentinel Iymph nodes were removed from 33 patients with operable breast cancer. The results of imprint cytology were compared with those of the serial section of SN stained using the combined H&E and IHC methods. The sensitivity of intraoperative SN imprint ICC was 33%, the specificity 94% and the accuracy 66%. The positive predictive value of the imprint ICC was 83% and the negative predictive value 63%.
Conclusions: The intraoperative SN imprint ICC in this study was found to have 33% sensitivity, 66% accuracy and low negative predictive value when compared with serial section with combined H&E and IHC. The intraoperative SN imprint ICC alone is not sufficient to be used as a guide to avoid axillary lymph node dissection in operable breast cancer.
References
2. Singletary SE, Allred C, Ashley AP, et al, Revision of the American Joint Committee on Cancer Staging System for Breast Cancer. J Clin Oncol 2002; 20: 3628-36.
3. Singletary SE, Greene FL, Sobin LH. Classification of isolated tumor cells; clarification of the 6th edition of the American Joint Committee of Staging Manual. Cancer 98:2003:2740.
4. Morton DL, Wen DR, Wong JH, et al. Technical details of intra-operative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127: 392-9.
5. Giuliano AE. Sentinel lymphadenectomy in primary breast carcinoma: an alternative to routine axillary dissection. J Surg Oncol 1996; 62: 75-7.
6. Veronesi U, Paganelli G, Galimberti V, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 1997; 349: 1864-7,
7. Chu KU, Turner RR, Hansen NM, et al. Sentinel node metastasis in patients with breast carcinoma accurately predicts immunohistochemically detectable non sentinel node metastasis. Ann Surg Oncol 1999: 6: 756-61.
8. Tan YY, Wu CT, Fan YA, et al. Primary tumor characteristics predict sentinel lymph node micrometastasis in breast cancer. Breast J 2005; 11: 338-43.
9. Mansel RE, Fallowfield L, Kissim M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial. J Natl Cancer Inst 2006; 98: 599-609.
10. Seigler HF. Axillary lymph node dissection versus the sentinel lymph node technique in breast cancer. Ann Surg 2004;1:7-8.
11. Smeets A, Christiaens MR. Implications of the sentinel lymph node procedure for local and systemic adjuvant treatment. Curr Opi Oncol 2005; 17: 539-44.
12. Goyal A, Newcombe RG, Chhabra A, et al. Factors affection failed localization and false-negative rates of sentinel node biopsy in breast cancer-results of the ALMANAC validation phase. Breast Cancer Res Treat 2006; 16; (Epub ahead to print).
13. Zurrida S, Galimberti V, Orvieto E, et al. Radioguided sentinel node biopsy to avoid axillary dissection in breast cancer. Ann Surg Oncol 2000; 7: 28-31.
14. Salem AA, Douglas-Jones G, Sweetland HM, et al. Evaluation of axillary lymph nodes using tough imprint cytology and immunohistochemistry. Br J Surg 2002; 89: 1386-9.
15. Celebioglu F, Sylvan M, Perbedk L, et al, Intraoperative sentinel lymph examination by frozen section, immunohistochemistry and imprint cytology during breast surgery – a prospective study, Euro J Cancer 2006; 42: 617-20.
16. Taupradist P, Puttawibul P, Kanngurn S, et al. Preliminary analysis of sentinel node imprint cytology with cytokeratin stained technique in breast cancer patients. Presented of the meeting of the Royal College of Surgeons of Thailand General Surgery session. Bangkok, Nov 2005.
17. Deo S, Samaiya A, Jain P, et al. Sentinel lymph node biopsy assessment using intraoperative imprint cytology in breast cancer patients: results of a validation study. Asian J Surg 2004;27:294-8.
18. Kane 3rd JM, Edge SB, Sinston JS, et al. Intraoperative pathologic evaluation of a breast cancer sentinel lymph node biopsy as a determinant for synchronous axillary lymph node. Ann Surg Oncol 2001: 8: 361-7.
19. Zgajnar J, Frkovic-grazio S, Besic N, et al. Low sensitivity Of the touch imprint cytology of the sentinel lymph node in breast cancer patients. Results of a large series. J Surg Oncol 2004;85: 82-6.
20, Pogacnik A, Klopcic U, Grazio-Frkovic S, et al. The reliability and accuracy of intraoperative imprint cytology of sentinel lymph nodes in breast cancer. Cytopathology 2005; 16:71-6
21. Cox C, Centeno B, Dickson D, et al. Accuracy of intraoperative imprint cytology for sentinel lymph node evaluation in the treatment of breast carcinoma. Cancer 2005;105:13-20.
22. Chicken DW, Kocjan G, Falzon M, et al. Intraoperative touch imprint cytology for the diagnosis of sentinel lymph node metastases in breast cancer. Br J Surg 2006;93:572-6
23. Motomura K, Inaji H, Komoike Y, et al, Intraoperative sentinel lymph node examination by imprint cytology and frozen sectioning during breast surgery. Br J Surg 2000;87:597-601.
24. Starz H, Balda BR, Kramer KU, et al. A micromorphometry based concept for routine classification of sentinel lymph node metastases and its clinical relevance for patients with melanoma. Cancer 2001;91:2110-20.
25. Viale G, Maiorano E, Pruneri G, et al. Predicting the risk for additional axillary metastasis in patients with breast carcinoma and positive sentinel lymph node biopsy. Ann Surg 2005; 241: 319-25.
26. Aihara T, Munakat S, Morino H, et al. Touch imprint cytology and immunohistochemisty for the assessment of sentinel lymph nodes in patients with breast cancer. Eur J Surg Onco 2003;29: 845-8.
27. Bleiweiss IJ, Nagi CS, Jaffer S. Axillary sentinel lymph nodes can be false positive due to iatrogenic displacement and transport of benign epithelial cells in patients with breast carcinoma. J Clin Oncol 2006; 24: 2013-8.
28. Carter BA. Sentinel lymph node histopathology in breast cancer: minimal disease versus artifact, J Clin Oncol 2006;24:1978-9.
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