Modified Alcian Blue Enhances the Intraoperative Diagnosis of Sentinel Lymph Node Metastasis in Invasive Lobular Carcinoma: A Prospective Study
C Fan, D Malik, S Kulkartni, N Daoud, D Tan, T Khoury. Roswell Park Cancer Institute, Buffalo; MD-Anderson, Houston
Background: The sensitivity of intraoperative diagnosis of sentinel lymph node (SLN) metastasis of invasive lobular carcinoma (ILC) using conventional staining is low. Multiple studies have used immunohistochemistry and polymerase chain reaction. However, these methods take long time for its purpose and are costly. The goal of our study was to develop a fast modified Alcian Blue (MAB) stain to decrease the intraoperative false negativity of metastases of ILC.
Design: A series of Alcian Blue staining modifications was conducted using fresh lobular carcinoma cases. After optimization with the shortest possible period and highest sensitivity, the procedure was used for intra-operative diagnosis (IOD). Patients that had ILC on needle biopsy and scheduled for SLN operation were candidates for the study. Two touch preparations from every SLN were prospectively prepared in the same manner, one stained with Hematoxylin and Eosin (H&E) and one with MAB. These slides were independently interpreted. Finally, all the permanent sections of the lymph nodes were stained with cytokeratin (AE 1/3).
Results: Twenty patients with ILC underwent SLN sampling (Table 1). Approaching data based on number of SLN, there were 16 of 70 (22.9%) positive SLN. The sensitivity for H&E and MAB was 43.8% and 81.3% respectively. Approaching data based on patients, there were 9 of 20 (45%) patients had at least one positive SLN. The sensitivity for H&E and MAB was 55.6% and 88.9% respectively. The specificity for both methods was 100%. The staining process takes 9 minutes.
Conclusions: MAB stain is relatively a rapid, cheap, highly sensitive and specific method of detecting metastatic ILC to SLN. This method can be used in conjunct with normally used intraoperative staining methods.
Results of H&E and MAB based on patients and lymph nodes
|Patient basis||Node basis|
|H & E||MAB||Section IHC||H & E||MAB||Section IHC|
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 27, Monday Morning