背景:前哨淋巴结(SLN)是从癌症涉及的特定区域排出淋巴的第一个淋巴结。用于SLN评估的常用术中方法是触摸印迹细胞学(TIC)和冷冻切片(FS)。本研究旨在确定灵敏度,以组织病理学诊断为金标准的TIC和FS的特异性和准确性。
方法:将节点沿它们的长轴切开,并在湿表面上印迹以清洁载玻片,然后进行甲苯胺蓝和快速Papanicolaou染色。随后,使用低温恒温器将淋巴结切片切成三个水平,并用苏木精和伊红染色剂染色。比较细胞学和FS结果,灵敏度,准确度,以组织病理学诊断为金标准,评估TIC和FS的阳性预测值(PPV)和阴性预测值(NPV)。此外,汇集灵敏度,特异性,正预测值,对于meta分析中纳入的研究,评估了触摸印迹细胞学和冰冻切片的阴性预测值和诊断准确性.
结果:特异性,灵敏度,诊断准确性,触摸印迹细胞学的阳性预测值和阴性预测值分别为100%,88.2%,90%,分别为100%和60%。特异性,灵敏度,诊断准确性,冷冻切片的PPV和NPV为100%,94.1%,95%,分别为100%和75%。TIC和FS检测微转移的敏感性分别为60%和80%。触摸印迹细胞学的合并敏感性和特异性为85.24%(95%CI,83.46%-86.90%),和98.99%(95%CI,98.69%-99.23%)。冷冻切片检查的合并敏感性和特异性为90.45%(95%CI,85.15%-94.34%),和100%(95%CI,99.24%-100%)。
结论:尽管FS在检测微转移方面的敏感性优于印迹细胞学,TIC是一种快速廉价的技术,可以在没有低温恒温器的偏远地区使用。两种技术在检测大转移方面的灵敏度相当。这项荟萃分析强调了触摸印记细胞学和冰冻切片检查在术中检测乳腺癌恶性肿瘤的准确性。
BACKGROUND: Sentinel lymph node (SLN) is the first lymph node to drain the lymph from a particular region involved by cancer. The commonly performed intraoperative methods for SLN evaluation are touch imprint cytology (TIC) and frozen section (FS). The present study aimed to determine the sensitivity, specificity and accuracy of TIC and FS with histopathological diagnosis as gold standard.
METHODS: The nodes were bissected along their long axis and wet surface was imprinted on to clean glass slides followed by toluidine blue and rapid Papanicolaou staining. Subsequently the lymph node slices were cut at three levels using the cryostat machine and stained with Hematoxylin and eosin stain. The cytological and FS findings were compared and the specificity, sensitivity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of TIC and FS was evaluated taking histopathological diagnosis as gold standard. In addition, pooled sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for touch imprint cytology and frozen section were assessed for the studies included in the meta-analysis.
RESULTS: The specificity, sensitivity, diagnostic accuracy, positive predictive value and negative predictive value of touch imprint cytology were 100%, 88.2%, 90%, 100% and 60% respectively. The specificity, sensitivity, diagnostic accuracy, PPV and NPV of frozen section were 100%, 94.1%, 95%, 100% and 75% respectively. The sensitivity of TIC and FS for detection of micrometastasis was 60% and 80% respectively. The pooled sensitivity and specificity for touch imprint cytology were 85.24% (95% CI, 83.46%-86.90%), and 98.99% (95% CI, 98.69%-99.23%) respectively. The pooled sensitivity and specificity for frozen section examination were 90.45% (95% CI, 85.15%-94.34%), and 100% (95% CI, 99.24%-100%) respectively.
CONCLUSIONS: Even though the sensitivity of FS was better than imprint cytology in detection of micrometastasis, TIC is a rapid inexpensive technique which can be utilized in remote areas in absence of cryostat machine. The sensitivity of the two techniques with respect to detection of macrometastasis was comparable. This meta-analysis highlights the accuracy of the touch imprint cytology and frozen section examination in the intra-operative detection of malignancy in breast cancer.