Hashmi Atif A, Naz Samreen, Ahmed Omer, Yaqeen Syed Rafay, Afzal Anoshia, Asghar Ishaq Azeem, Irfan Muhammad, Faridi Naveen
Pathology, Liaquat National Hospital and Medical College, Karachi, PAK.
Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK.
Cureus. 2021 Jan 28;13(1):e12960. doi: 10.7759/cureus.12960.
Introduction The intraoperative frozen section is a recommended method to detect breast cancer metastasis to axillary sentinel lymph nodes (SLNs); however, frozen section is not widely available and requires an experienced staff. Alternatively, touch imprint cytology (TIC) is a simple and cost-effective technique to detect metastasis. Therefore, in this study, we assessed the diagnostic accuracy of TIC for detecting SLN metastasis and compared it with intraoperative frozen section evaluation. Methodology A retrospective study was conducted in the Department of Histopathology, Liaquat National Hospital and Medical College, for a duration of two years. A total of 114 patients undergoing surgery for primary breast cancer were included in the study. All patients had clinically and radiologically negative axillary lymph nodes. SLN sampling was done using radioactive dye and sent for intraoperative consultation. The SLNs were sliced at 4-mm intervals and two TIC slides and three step-levels for frozen section were prepared, and the results were compared with final (paraffin) section histology. Results The sensitivity, specificity, and diagnostic accuracy of TIC was 83.7%, 98.5%, and 92.1%, respectively. Alternatively, the sensitivity, specificity, and diagnostic accuracy of frozen section was 93.9%, 100%, and 97.4%, respectively. The sensitivity of TIC and frozen section for detecting micrometastasis was 14.3% and 57.1%, respectively, with a diagnostic accuracy of 90.3% and 95.8%, respectively. Alternatively, with respect to macrometastasis, the sensitivity and specificity of TIC were 95.2% and 98.5%, respectively, while the sensitivity and specificity of frozen section were 100%. Conclusion TIC is a quick and effective technique for detecting breast cancer metastasis in axillary SLNs. Although frozen section had an overall higher sensitivity than TIC, the sensitivity of TIC for detecting macrometastasis was comparable to the frozen section. Therefore, we conclude that TIC is a good alternative to the frozen section in facilities where the frozen section is not available.
引言 术中冰冻切片是检测乳腺癌腋窝前哨淋巴结（SLN）转移的推荐方法；然而，冰冻切片并非广泛可用，且需要经验丰富的工作人员。另外，印片细胞学检查（TIC）是一种检测转移的简单且经济高效的技术。因此，在本研究中，我们评估了TIC检测SLN转移的诊断准确性，并将其与术中冰冻切片评估进行比较。
方法 在利亚卡特国家医院和医学院组织病理学系进行了一项为期两年的回顾性研究。共有114例接受原发性乳腺癌手术的患者纳入研究。所有患者的腋窝淋巴结在临床和放射学检查中均为阴性。使用放射性染料进行SLN取样并送去进行术中会诊。将SLN切成4毫米间隔的切片，制备两张TIC玻片和三张用于冰冻切片的连续切片，结果与最终（石蜡）切片组织学进行比较。
结果 TIC的敏感性、特异性和诊断准确性分别为83.7%、98.5%和92.1%。另外，冰冻切片的敏感性、特异性和诊断准确性分别为93.9%、100%和97.4%。TIC和冰冻切片检测微转移的敏感性分别为14.3%和57.1%，诊断准确性分别为90.3%和95.8%。另外，对于巨转移，TIC的敏感性和特异性分别为95.2%和98.5%，而冰冻切片的敏感性和特异性均为100%。
结论 TIC是检测腋窝SLN中乳腺癌转移的快速有效技术。虽然冰冻切片总体敏感性高于TIC，但TIC检测巨转移的敏感性与冰冻切片相当。因此，我们得出结论，在没有冰冻切片的机构中，TIC是冰冻切片的良好替代方法。
