Creager Andrew J, Geisinger Kim R, Shiver Stephen A, Perrier Nancy D, Shen Perry, Ann Shaw Jo, Young Peter R, Levine Edward A
Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
Mod Pathol. 2002 Nov;15(11):1140-7. doi: 10.1097/01.MP.0000036385.54165.E1.
The increasing utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes attractive. Axillary lymph node dissection can be performed during the initial surgery if the sentinel lymph node is positive, potentially avoiding a second operative procedure. At present the optimal technique for rapid sentinel lymph node assessment has not been determined. Both frozen sectioning and intraoperative imprint cytology are used for rapid intraoperative sentinel lymph node evaluation at many institutions. The purpose of this study is to evaluate experience with imprint cytology for intraoperative evaluation of sentinel lymph nodes in patients with breast cancer.
A retrospective review of the intraoperative imprint cytology results of 678 sentinel lymph node mappings for breast carcinoma was performed. Sentinel nodes were evaluated intraoperatively by either bisecting or slicing the sentinel node into 4 mm sections. Imprints were made of each cut surface and stained with H&E and/or Diff-Quik. Permanent sections were evaluated with up to four H&E stained levels and cytokeratin immunohistochemistry. Intraoperative imprint cytology results were compared with final histologic results.
The sensitivity of imprint cytology was 53%, specificity was 98%, positive predictive value was 94%, negative predictive value was 82% and accuracy was 84%. The sensitivity for detecting macrometastases (more than 2mm) was significantly better than for detecting micrometastases (<or=2 mm), 81 versus 21%, respectively (P < 00001).
The sensitivity and specificity of imprint cytology are similar to that of intraoperative frozen section evaluation. Imprint cytology is therefore a viable alternative to frozen sectioning when intraoperative evaluation is required. If sentinel lymph node micrometastasis is used to determine the need for further lymphadenectomy, more sensitive intraoperative methods will be needed to avoid a second operation.
淋巴绘图技术在乳腺癌中的应用日益增加，使得术中对前哨淋巴结进行评估变得具有吸引力。如果前哨淋巴结呈阳性，可在初次手术时进行腋窝淋巴结清扫，这有可能避免二次手术。目前，尚未确定快速评估前哨淋巴结的最佳技术。在许多机构中，冰冻切片和术中印片细胞学检查都用于术中快速评估前哨淋巴结。本研究的目的是评估印片细胞学检查在乳腺癌患者术中评估前哨淋巴结的经验。
对678例乳腺癌前哨淋巴结绘图的术中印片细胞学检查结果进行回顾性分析。术中通过将前哨淋巴结一分为二或切成4毫米的切片来评估前哨淋巴结。对每个切面制作印片，并用苏木精和伊红（H&E）和/或Diff-Quik染色。对永久切片进行多达四个H&E染色水平和细胞角蛋白免疫组织化学评估。将术中印片细胞学检查结果与最终组织学结果进行比较。
印片细胞学检查的敏感性为53%，特异性为98%，阳性预测值为94%，阴性预测值为82%，准确性为84%。检测大转移灶（大于2毫米）的敏感性明显优于检测微转移灶（小于或等于2毫米），分别为81%和21%（P<0.0001）。
印片细胞学检查的敏感性和特异性与术中冰冻切片评估相似。因此，当需要术中评估时，印片细胞学检查是冰冻切片检查的可行替代方法。如果用前哨淋巴结微转移来确定是否需要进一步进行淋巴结清扫，则需要更敏感的术中方法来避免二次手术。
