Shiver Stephen A, Creager Andrew J, Geisinger Kim, Perrier Nancy D, Shen Perry, Levine Edward A
Department of Surgery, Surgical Oncology Service, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA.
Am J Surg. 2002 Nov;184(5):424-7. doi: 10.1016/s0002-9610(02)01003-6.
The utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes (SLN) attractive, because axillary lymph node dissection can be performed during the initial surgery if the SLN is positive. The optimal technique for rapid SLN assessment has not been determined. Both frozen sectioning and imprint cytology are used for rapid intraoperative SLN evaluation.
A retrospective review of the intraoperative imprint cytology results of 133 SLN mapping procedures from 132 breast carcinoma patients was performed. SLN were evaluated intraoperatively by bisecting the lymph node and making imprints of each cut surface. Imprints were stained with hematoxylin and eosin (H&E) and Diff-Quik. Permanent sections were evaluated with up to four H&E stained levels and cytokeratin immunohistochemistry. Imprint cytology results were compared with final histologic results.
Sensitivity and specificity of imprint cytology were 56% and 100%, respectively, producing a 100% positive predictive value and 88% negative predictive value. Imprint cytology was significantly more sensitive for macrometastasis than micrometastasis 87% versus 22% (P = 0.00007). Of 13 total false negatives, 11 were found to be due to sampling error and 2 due to errors in intraoperative interpretation. Both intraoperative interpretation errors involved a diagnosis of lobular breast carcinoma.
The sensitivity and specificity of imprint cytology are similar to that of frozen section evaluation. Imprint cytology is therefore a viable alternative to frozen sectioning when intraoperative evaluation is required. If SLN 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使得前哨淋巴结（SLN）的术中评估具有吸引力，因为如果前哨淋巴结为阳性，可在初次手术时进行腋窝淋巴结清扫。快速评估前哨淋巴结的最佳技术尚未确定。冰冻切片和印片细胞学检查均用于前哨淋巴结的术中快速评估。
对132例乳腺癌患者的133例前哨淋巴结绘图手术的术中印片细胞学检查结果进行回顾性分析。术中通过将淋巴结对半切开并在每个切面制作印片来评估前哨淋巴结。印片用苏木精和伊红（H&E）染色及Diff-Quik染色。永久切片用多达四个苏木精和伊红染色层及细胞角蛋白免疫组织化学进行评估。将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和特异性分别为56%和100%，阳性预测值为100%，阴性预测值为88%。印片细胞学检查对大转移灶的敏感性明显高于微转移灶，分别为87%和22%（P = 0.00007）。在13例总的假阴性病例中，11例是由于取样误差，2例是由于术中判读错误。术中判读错误的两例均涉及小叶型乳腺癌的诊断。
印片细胞学检查的敏感性和特异性与冰冻切片评估相似。因此，在需要术中评估时，印片细胞学检查是冰冻切片的一种可行替代方法。如果用前哨淋巴结微转移来决定是否需要进一步行淋巴结清扫术，则需要更敏感的术中方法以避免二次手术。
