Intraoperative Cytologic Evaluation of Sentinel Lymph Nodes in Breast Cancer: A Community Hospital Experience
MA Siddiqui, X Chen, VC Lucia, A Ellis, DM Grossman. William Beaumont Hospitals, Troy, MI; William Beaumont Hospitals, Royal Oak, MI
Background: Cytological evaluation of sentinel lymph node (SN) is a rapid method of providing intraoperative consultation to the surgeon regarding staging in patients with breast cancer. A positive finding permits an immediate complete dissection, avoiding the need for a second operation on the axilla. A negative finding obviates the need for complete dissection, thus decreasing the morbidity. The purpose of this study was to assess the reliability of intraoperative cytologic examination of SN (ICE) at a busy community hospital.
Design: A retrospective review of ICE in patients with invasive breast carcinoma was conducted from 2004 to 2007 at William Beaumont Hospital, Troy, MI. SNs were identified by radioisotope and blue dye. The SNs were evaluated by a pathologist by sectioning at 2 mm, and examining scraped smears stained by hematoxylin and eosin. The ICE result was compared to final results of permanent sections. Negative SNs in routine sections were routinely evaluated by immunohistochemical stain for CK AE1/AE3.
Results: 795 patients with invasive carcinoma underwent ICE during breast procedures (biopsy/lumpectomy, mastectomy, re-excision). The average age of patients was 58.7 years, with an average tumor size of 18.3 mm. A total of 2662 SN were examined with an average of 3.3 SN submitted per patient. 275 positive SN were identified in 125 patients. Of these, 208 were detected by ICE. The overall sensitivity of detecting a positive SN was 75.6% and specificity was 100%, with positive and negative predictive values of 100% and 97.3%, respectively. The detection of macrometastasis by ICE was 87.6% compared to 2.5% for micrometastasis and isolated tumor cells. The sensitivity for detection of positive SN was similar for patients with ductal (67.6%, n=142) and lobular (70.0%, n=30) carcinoma. Axillary dissection was completed immediately in 123 of the 125 patients when ICE was reported as positive.
Conclusions: Intraoperative cytologic examination is a simple and reliable method for evaluation of sentinel lymph nodes in patients with breast cancer. Detection of a positive SN by ICE permits complete surgical staging of the axilla, thereby avoiding the psychological, physical, and financial impact on the patient of a second operation.
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 69, Tuesday Morning