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From the Fashion Footwear Association of New York/Virginia Clinton Kelley Research Fellowship (ATJ, LFS), University of Arkansas for Medical Sciences, Arkansas Cancer Research Center (ITR), Department of Veterans Affairs, Central Arkansas Veterans Healthcare System, Department of Surgery (RSH-T, ATJ, ATM, LFS, KCW, VSK) and Department of Pathology (SK, NM, VSK), Little Rock, Arkansas.
Correspondence: Address correspondence and reprint requests to: Ronda S. Henry-Tillman, MD, 4301 West Markham, Slot 725, Little Rock, AR 72205; Fax: 501-686-7861; E-mail: henryrondas{at}uams.edu
Background: The optimal technique for intraoperative pathologic examination of sentinel lymph nodes (SLNs) is still controversial. Recent small series report sensitivity between 60% and 100% for various techniques. The aim of this study was to evaluate our long-term experience with touch preparation cytology (TPC) and frozen section (FS) in the intraoperative examination of SLNs for breast cancer.
Methods: A total of 247 patients with operable breast cancer underwent an SLN biopsy for staging of the axilla. The SLN was identified by 99mTc-labeled sulfur colloid unfiltered dye, blue dye, or both and dissected, and then intraoperative TPC or FS and permanent section, or both, were performed.
Results: A total of 479 SLNs were submitted for TPC and permanent hematoxylin and eosin. A total of 68 SLNs were positive by hematoxylin and eosin; 65 SLNs were positive by TPC, with a false-negative rate of 5.8%. The sensitivity for TPC was 94.2%, with a false-positive rate of 0.2%. A total of 165 SLNs were submitted for FS, with a sensitivity of 85.7% and a specificity of 98.6%. The false-positive rate was 1.4%, with a false-negative rate of 15.8%.
Conclusions: In a large series, TPC is as accurate as FS but is simpler and faster in the detection of intraoperative metastasis in SLNs for breast cancer.
Key Words: Sentinel lymph node • Breast cancer • Touch preparation cytology • Frozen section • Accuracy
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