Department of Pathology, College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Cancer Med. 2021 Oct;10(20):7213-7221. doi: 10.1002/cam4.4264. Epub 2021 Sep 17.
Intraoperative consultation (IOC) of axillary sentinel lymph node (SLN) biopsy continues to play a role in selected breast cancer patients. The reported sensitivity rates for intraoperative SLN evaluation in breast cancer range from 47% to 80%. We study a center where the majority of SLN IOC is performed by imprint cytology, and a protocol was established to limit microscopic examination to three slides for a reporting TAT goal of 30 min.
Approval to conduct this study was obtained from the REB. A retrospective review was performed on all consecutive SLN cases sent for IOC. Reported IOC assessments of all cases were compared with the final pathology.
Of 164 patients, there were 22 (13%) false negative IOC events, including 15 missed macro-metastasis and 7 missed micro-metastasis. The overall sensitivity for touch imprint in detecting SLNs macro-metastasis was 70.9%. Reporting total turnaround time was on average 3 min longer, whereas sensitivity and specificity were not significantly different in the two protocol periods.
Implementation of an IOC policy for a maximum of three slides for imprint cytology did not result in a significant impact on the sensitivity, specificity, or total turnaround time for SLN in breast cancer patients. False negative IOC events were mainly due to sampling error. Quality review was made difficult by limited documentation related to the gross handling of the specimens at IOC. System factors identified include insufficient space for the IOC report on the pathology requisition, and the lack of clearly communicated expectations for documentation.
腋窝前哨淋巴结（SLN）活检的术中咨询（IOC）在选定的乳腺癌患者中仍继续发挥作用。在乳腺癌中，术中 SLN 评估的报告敏感性率为 47%至 80%。我们研究了一个中心，该中心的大多数 SLN IOC 由印片细胞学完成，并制定了一项方案，将显微镜检查限制为三张幻灯片，以达到 30 分钟的报告周转时间目标。
获得了 REB 的批准，对所有连续进行 SLN IOC 的病例进行了回顾性审查。将所有病例的报告 IOC 评估与最终病理学进行了比较。
在 164 例患者中，有 22 例（13%）为假阴性 IOC 事件，包括 15 例漏诊的大转移和 7 例漏诊的微小转移。触印在检测 SLN 大转移方面的总体敏感性为 70.9%。报告的总周转时间平均延长了 3 分钟，但在两个方案期间，敏感性和特异性没有显著差异。
为印片细胞学最多制定三个幻灯片的 IOC 政策的实施并未对乳腺癌患者的 SLN 敏感性、特异性或总周转时间产生显著影响。假阴性 IOC 事件主要归因于取样误差。由于 IOC 时标本的大体处理相关的记录有限，质量审查变得困难。确定的系统因素包括：IOC 报告在病理学申请上的空间不足，以及对记录的期望缺乏明确沟通。
