Menes Tehillah S, Tartter Paul Ian, Mizrachi Howard, Smith Sharon Rosenbaum, Estabrook Alison
Departments of Surgery, St. Luke's-Roosevelt Hospital Center, New York, New York 10019, USA.
Ann Surg Oncol. 2003 Dec;10(10):1166-70. doi: 10.1245/aso.2003.04.023.
The preferred technique for intraoperative evaluation of the sentinel lymph node has not been determined. The purpose of this study was to compare the sensitivity and accuracy of intraoperative evaluation of the sentinel lymph node by touch preparation cytology and frozen section.
A total of 117 patients with clinically node-negative breast cancer or ductal carcinoma-in-situ undergoing sentinel lymph node biopsy had intraoperative evaluation of the sentinel node by touch preparation, frozen section, or both. The results of the intraoperative evaluation were compared with the final histological results of hematoxylin and eosin (H&E) paraffin section and immunohistochemistry (IHC).
Twenty-six (57%) of the 46 patients with nodal involvement had metastases detected during surgery. The sensitivity of touch preparation for detecting macrometastases was 78%; for detecting all H&E metastases, including micrometastases, was 57%; and for detecting all metastases, including those seen on IHC, was 40%. The sensitivity of frozen section for detecting macrometastases was 83%; for detecting all H&E metastases, including micrometastases, was 78%; and for detecting all metastases, including those seen on IHC, was 64%. Both have a low sensitivity for micrometastases seen by H&E paraffin section: 57% and 78%, respectively. Neither detected micrometastases diagnosed by IHC only.
Both touch preparation and frozen section seem to be accurate in detecting macrometastases, but not micrometastases. Intraoperative evaluation of the sentinel lymph node by touch preparation allows for a quick evaluation of the node without wasting significant tissue and without detecting occult microscopic metastases, which may be beneficial because the clinical importance of these has yet to be elucidated.
前哨淋巴结术中评估的首选技术尚未确定。本研究的目的是比较通过印片细胞学检查和冰冻切片进行前哨淋巴结术中评估的敏感性和准确性。
共有117例临床淋巴结阴性的乳腺癌或原位导管癌患者接受了前哨淋巴结活检，并通过印片、冰冻切片或两者对前哨淋巴结进行术中评估。术中评估结果与苏木精-伊红（H&E）石蜡切片和免疫组织化学（IHC）的最终组织学结果进行比较。
46例有淋巴结转移的患者中，26例（57%）在手术中检测到转移。印片检测大体转移灶的敏感性为78%；检测所有H&E转移灶（包括微转移灶）的敏感性为57%；检测所有转移灶（包括IHC检测到的转移灶）的敏感性为40%。冰冻切片检测大体转移灶的敏感性为83%；检测所有H&E转移灶（包括微转移灶）的敏感性为78%；检测所有转移灶（包括IHC检测到的转移灶）的敏感性为64%。两者对H&E石蜡切片所见微转移灶的敏感性均较低，分别为57%和78%。两者均未检测到仅由IHC诊断的微转移灶。
印片和冰冻切片在检测大体转移灶方面似乎都很准确，但在检测微转移灶方面不准确。通过印片对前哨淋巴结进行术中评估可快速评估淋巴结，而不会浪费大量组织，也不会检测到隐匿的微小转移灶，这可能是有益的，因为这些微小转移灶的临床重要性尚未阐明。
