Petropoulou Thalia, Kapoula Antonia, Mastoraki Aikaterini, Politi Aikaterini, Spanidou-Karvouni Eleni, Psychogios Ioannis, Vassiliou Ioannis, Arkadopoulos Nikolaos
2nd Department of Surgery.
Department of Pathology, Aretaieion University Hospital.
Breast Cancer (Dove Med Press). 2017 May 5;9:325-330. doi: 10.2147/BCTT.S130987. eCollection 2017.
Sentinel lymph node (SLN) biopsy is the gold standard for surgical staging of the axilla in breast cancer (BC). Frozen section (FS) remains the most popular means of intraoperative SLN diagnosis. Imprint cytology (IC) has also been suggested as a less expensive and equally accurate alternative to FS. The aim of our study was to perform a direct comparison between IC and FS on the same SLNs of BC cases operated in a single center by the same surgical team.
Into this prospective study we enrolled 60 consecutive patients with histologically proven T1-T3 BC and clinically negative axilla. Sentinel nodes were detected using a standard protocol. The SLN(s) was always assessed by IC as well as FS analysis and immunohistochemistry. Nevertheless, all intraoperative decisions were based on FS analysis.
During the study period 60 patients with invasive BC were registered, with 80 SLNs harvested. Mean number of SLN(s) identified for each patient was 1.33. The sensitivity and specificity were 90% and 100%, respectively, for IC, and 80% and 100% for FS. Relevant positive/negative predictive values were 100%/98% for IC and 100%/96.15%, respectively, for FS. Overall accuracy was 98% for IC and 97% for FS. Therefore, statistically significant difference between the two methods in the detection of positive nodes was not elucidated (=1.000).
IC appeared to be marginally more sensitive than FS in detecting SLN metastatic activity. Overall accuracy was 98.75%. With regard to the primary lesion characteristics, we conclude that initial lesion size and lymphovascular invasion play a pivotal role in metastatic involvement of the SLN with the dimensions of metastasis bearing no correlation with tumor size. Therefore, IC appears to be a sensitive and accurate method for the intraoperative assessment of SLN in BC patients, but further studies are required to confirm this interesting data.
前哨淋巴结（SLN）活检是乳腺癌（BC）腋窝手术分期的金标准。冰冻切片（FS）仍是术中SLN诊断最常用的方法。印片细胞学检查（IC）也被认为是一种成本较低且准确性相当的FS替代方法。我们研究的目的是在同一中心由同一手术团队操作的BC病例的相同SLN上，对IC和FS进行直接比较。
在这项前瞻性研究中，我们连续纳入了60例经组织学证实为T1 - T3期BC且腋窝临床阴性的患者。使用标准方案检测前哨淋巴结。SLN始终通过IC以及FS分析和免疫组化进行评估。然而，所有术中决策均基于FS分析。
在研究期间，登记了60例浸润性BC患者，共获取80个SLN。每位患者识别出的SLN平均数量为1.33个。IC的敏感性和特异性分别为90%和100%，FS的敏感性和特异性分别为80%和100%。IC的相关阳性/阴性预测值分别为100%/98%，FS的相关阳性/阴性预测值分别为100%/96.15%。IC的总体准确率为98%，FS的总体准确率为97%。因此，两种方法在检测阳性淋巴结方面未发现统计学上的显著差异（P = 1.000）。
在检测SLN转移活性方面，IC似乎比FS稍敏感。总体准确率为98.75%。关于原发灶特征，我们得出结论，初始病灶大小和淋巴管浸润在SLN转移累及中起关键作用，转移灶大小与肿瘤大小无关。因此，IC似乎是BC患者术中评估SLN的一种敏感且准确的方法，但需要进一步研究来证实这些有趣的数据。
