Hamidian Jahromi Alireza, Narayanan Sankaran, MacNeill Fiona, Osin Peter, Nerurkar Ashutash, Gui Gerald
Renal Transplant Department, St George's Hospital, London, UK.
Ann R Coll Surg Engl. 2009 May;91(4):336-9. doi: 10.1308/rcsann.2009.91.4.336. Epub 2009 Apr 2.
Sentinel lymph node biopsy is emerging as the new standard for axillary staging in breast cancer. Intra-operative assessment of the sentinel lymph nodes allows immediate completion of axillary dissection during the same anaesthetic. This project was a quality assurance practice to establish feasibility, time-to-report, as well as accuracy of performing intra-operative assessment of sentinel lymph nodes using touch imprint cytology in our centre.
This prospective audit included 146 sentinel lymph nodes from 74 consecutive patients with invasive breast cancer. All patients underwent axillary sentinel lymph node biopsy using combined blue dye and radiocolloid technique. Results of intra-operative touch imprint cytology using haematoxylin and eosin staining were compared with the definitive histopathology results.
Mean time to report touch imprint cytology was 25.7 +/- 6.4 min (range, 15-40 min). Histopathology demonstrated metastasis in 25 sentinel nodes from 17 (23%) patients. Intra-operative touch imprint cytology detected 15 nodes in 11 patients, giving a sensitivity of 60% (nodes) and 66.7% (patients) and specificity of 99.2% (nodes) and 98.2% (patients) based on the number of nodes and patients involved, respectively. Touch imprint cytology failed to show metastatic involvement in 10 nodes from 6 patients; of these, five nodes had micrometastasis (< 2 mm) and the other five had macrometastasis. One touch imprint cytology positive node contained isolated tumour cells only. Using intra-operative touch imprint cytology made a change in treatment of 11(14.9%) patients, and spared second axillary procedure in 7 (9.4%) patients.
Intra-operative sentinel lymph node assessment using touch imprint cytology is feasible within a busy NHS practice. We now offer touch imprint cytology to patients following appropriate counselling.
前哨淋巴结活检正逐渐成为乳腺癌腋窝分期的新标准。术中对前哨淋巴结进行评估可在同一麻醉过程中立即完成腋窝清扫。本项目是一项质量保证实践，旨在确定在我们中心使用触摸印片细胞学进行前哨淋巴结术中评估的可行性、报告时间以及准确性。
这项前瞻性审计纳入了74例连续的浸润性乳腺癌患者的146个前哨淋巴结。所有患者均采用联合蓝色染料和放射性胶体技术进行腋窝前哨淋巴结活检。将苏木精和伊红染色的术中触摸印片细胞学结果与最终组织病理学结果进行比较。
触摸印片细胞学报告的平均时间为25.7 +/- 6.4分钟（范围为15 - 40分钟）。组织病理学显示17例（23%）患者的25个前哨淋巴结有转移。术中触摸印片细胞学在11例患者中检测到15个淋巴结，根据涉及的淋巴结和患者数量，敏感性分别为60%（淋巴结）和66.7%（患者），特异性分别为99.2%（淋巴结）和98.2%（患者）。触摸印片细胞学未能显示6例患者的10个淋巴结有转移；其中，5个淋巴结有微转移（< 2 mm），另外5个有大转移。1个触摸印片细胞学阳性的淋巴结仅含有孤立肿瘤细胞。使用术中触摸印片细胞学使11例（14.9%）患者的治疗方案发生了改变，并使7例（9.4%）患者免于二次腋窝手术。
在繁忙的英国国家医疗服务体系（NHS）实践中，使用触摸印片细胞学进行术中前哨淋巴结评估是可行的。我们现在在适当咨询后为患者提供触摸印片细胞学检查。
