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Published on: August 23, 2007
Evaluation of axillary lymph nodes using touch imprint cytology and immunohistochemistry
A A Salem1, A G Douglas-Jones, H M Sweetland
1Department of Surgery, University of Wales College of Medicine, Cardiff, UK. salemaa1@cf.ac.uk
Insights
Immunohistochemistry (IHC) of touch imprints offers a rapid and sensitive method for detecting axillary lymph node metastases during breast cancer surgery. This technique aids in accurate intraoperative assessment, improving patient management.
Area of Science:
- Oncology
- Surgical Pathology
Background:
- Sentinel node biopsy is crucial for axillary lymph node staging in breast cancer.
- Accurate intraoperative assessment of lymph nodes is essential for surgical decision-making.
Purpose of the Study:
- To evaluate the feasibility and accuracy of immunohistochemistry (IHC) on touch imprints for intraoperative detection of axillary nodal metastases.
- To compare the diagnostic performance of IHC with routine hematoxylin and eosin (H&E) staining.
Main Methods:
- 344 axillary lymph nodes from 30 early breast cancer patients were analyzed.
- Nodes were bisected, imprinted, and subjected to IHC, with results compared to H&E staining.
Main Results:
- IHC identified metastases in 29 nodes (9 patients), while H&E identified 28 nodes (8 patients).
- On a patient basis, IHC showed 100% sensitivity and 100% NPV; H&E showed 88.9% sensitivity and 95.5% NPV.
- On a node basis, IHC sensitivity was 96.7% and NPV was 99.7%; H&E sensitivity was 93.3% and NPV was 99.3%.
- Results were available within 30-45 minutes with no false positives.
Conclusions:
- IHC of touch imprints is a fast and highly sensitive method for intraoperative detection of breast cancer metastases in axillary lymph nodes.
- This technique supports accurate staging and timely surgical management during breast cancer operations.
Background:
The success of sentinel node biopsy in determining axillary lymph node status necessitates an accurate and rapid method for intraoperative examination of the nodes. The aim was to determine the feasibility and accuracy of immunohistochemistry (IHC) of touch imprints in detecting axillary nodal metastases intraoperatively.
Methods:
Some 344 axillary nodes from 30 patients with early breast cancer were bisected, imprinted and subjected to IHC. Results were compared with those of routine haematoxylin and eosin examination of the same nodes.
Results:
Using IHC, 29 nodes from nine patients were positive for metastases. Using haematoxylin and eosin, 28 nodes from eight patients were positive. On a patient basis, the sensitivities of IHC and haematoxylin and eosin were 100 and 88.9 per cent, and negative predictive values (NPVs) were 100 and 95.5 per cent, respectively. On a node basis, the sensitivities were 96.7 and 93.3 per cent, and NPVs were 99.7 and 99.3 per cent, respectively. There were no false positives. The results were obtained within 30-45 min, depending on the number of nodes examined.
Conclusion:
IHC of touch imprints can provide a fast and sensitive method for detecting metastases in axillary nodes during breast cancer surgery.
