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Meta-Analysis
. 2024 Apr 1;25(4):1113-1119.
doi: 10.31557/APJCP.2024.25.4.1113.

Comparison of Intraoperative Imprint Cytology versus Frozen Section for Sentinel Lymph Node Evaluation in Breast Cancer. A study along with Systematic Review and Meta-analysis of literature

Sana Ahuja  1 , Priya Yadav  1 , Marzieh Fattahi-Darghlou  2 , Sufian Zaheer  1
Affiliations
Meta-Analysis

Comparison of Intraoperative Imprint Cytology versus Frozen Section for Sentinel Lymph Node Evaluation in Breast Cancer. A study along with Systematic Review and Meta-analysis of literature

Sana Ahuja et al. Asian Pac J Cancer Prev. .

Abstract

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.

Materials and 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.

Conclusion: 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.

Keywords: Meta-analysis; Sentinel Lymph Node; breast cancer; frozen section; touch imprint cytology.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Touch Imprint Cytology and Frozen Section in Sentinel Lymph Node. a, b) Touch imprint cytology smears from a case reported as positive for malignancy exhibiting singly scattered atypical cells with enlarged hyperchromatic nuclei, scant cytoplasm against a lymphoid background. [Toluidine blue stain, x40]. c, d) Frozen section examination shows sheets of tumor cells exhibiting moderate pleomorphism with enlarged hyperchromatic nuclei, scant cytoplasm. [Hematoxylin and eosin, x10, x40]
Figure 2
Figure 2
PRISMA Flow Diagram for Selection of Studies
Figure 3
Figure 3
Methodological Quality Summary: Review Authors' Judgements About Each Methodological Quality Item For Each Included Study
Figure 4
Figure 4
Methodological Quality Graph: review authors' judgements about each methodological quality item presented as percentages across all included studies
Figure 5
Figure 5
Forest Plot of Sensitivity and Specificity of Touch Imprint Cytology
Figure 6
Figure 6
Forest Plot of Sensitivity and Specificity of Frozen Section
See this image and copyright information in PMC

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