Intraoperative Evaluation of Axillary Sentinel Lymph Nodes Using Touch Imprint Cytology and Rapid Immunohistochemistry
M Hameed, Q Ahmed, N Uddin, M Tehsin, A Khan, N Sacks. Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Punjab, Pakistan
Background: Haematoxylin and eosin stained frozen sections (FS) are traditionally used for the intraoperative evaluation of sentinel axillary lymph nodes. The aim of our study was to compare FS with touch imprint cytology (TIC) and ultra rapid immunohistochemistry (IHC) as intraoperative diagnostic tool.
Design: TIC and ultra rapid IHC (Choi et-al Jpn J Clin Oncol 2006) were performed on 62 consecutive cases of fresh axillary sentinel lymph nodes biopsies and compared with FS. Permenant Paraffin section H&E diagnosis was taken as gold standard. TIC smears were prepared from every corresponding tissue submitted for frozen section. Ultra rapid IHC (CK AE1/AE3) took 25 min and was performed at the same time.
Results: Final diagnosis on paraffin section showed 27 cases with axillary sentinel node metastasis, including 6 micrometastasis. The frozen section H&E detected 26(96.3%) positive lymph nodes. 1 case of micrometastasis was missed on FS. TIC detected 21(77.7%) metastasis; 6 metastatic tumors were missed including 5 micrometastasis. 1 case of metastatic carcinoma was missed due to poor smear technique. IHC detected 25(92.6%) metastasis, 2 metastatic deposits failed to pick the immunostain, however, all cases of micrometastases were positive. Final results are shown in table 1.
|POSITIVE PREDICTIVE VALUE||100%||96%||100%|
|NEGATIVE PREDICTIVE VALUE||85.36%||91.89%||97.22%|
Conclusions: Our study shows that frozen section H&E remains superior to TIC & ultra rapid IHC in detecting axillary sentinel node metastases. TIC missed 5 out of 6 (83.3%) micrometastasis and should not be considered a sole diagnostic technique for intraoperative diagnosis. Ultra rapid IHC is best at detecting micrometastasis, however, the procedure requires technical expertise.
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 66, Tuesday Morning