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. 2025 Jul 25;17(7):e88784.
doi: 10.7759/cureus.88784. eCollection 2025 Jul.

Validity of Intraoperative Imprint Cytology and Frozen Section for Sentinel Lymph Node Assessment in Breast Cancer: A Single-Centre Experience

Kopinath Kathirvetpillai  1 , Sharon R Constantine  2
Affiliations

Validity of Intraoperative Imprint Cytology and Frozen Section for Sentinel Lymph Node Assessment in Breast Cancer: A Single-Centre Experience

Kopinath Kathirvetpillai et al. Cureus. .

Abstract

Background: Sentinel lymph node (SLN) evaluation is central to breast cancer management. Intraoperative touch imprint cytology (TIC) and frozen section (FS) are standard, rapid techniques; however, their performance compared to the gold standard of histopathology in Sri Lanka is underreported. This study evaluates the validity of intraoperative TIC and FS in identifying SLN metastases in patients with breast cancer.

Methods: We retrospectively analysed 416 SLN biopsies (2018-2020), with all cases assessed by TIC, FS, and subsequent paraffin histology. Demographic and clinicopathologic features were correlated with diagnostic metrics.

Results: Mean patient age was 55.9 years. Tumour sizes were ≤20 mm in 23.6%, 21-50 mm in 66.6%, and ≥50 mm in 9.9%. Most cases (92.1%) were invasive carcinoma of no special type (NST). Sensitivity and specificity for TIC were 90.6% and 100%; for FS, 92.7% and 100%. Combined TIC+FS yielded a sensitivity of 92.7% and a specificity of 100%. Detection rates for micrometastases were lower, and sensitivity for TIC was reduced in cases of lobular carcinoma and those where no LVI was found in the primary tumour.

Conclusion: Both TIC and FS individually showed high sensitivity (90.6% and 92.7%, respectively) and perfect specificity (100%) in the detection of metastatic deposits in SLNs. Combining TIC and FS maintained excellent specificity, while also maintaining the same sensitivity as FS alone. All three methods demonstrated consistently strong predictive values and overall accuracy, with limitations for smaller deposits and specific subtypes, such as invasive lobular carcinoma.

Keywords: breast cancer; frozen section; metastasis; sentinel lymph node; touch imprint cytology.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Ethical Review Committee of the National Hospital of Sri Lanka issued approval AAJ/ETH/COM/2021/APR on 29th April 2021. Approval permitted the collection of data through retrospective slide review over a 1-year period, as specified in the study protocol. The authors confirm that all data collection was conducted strictly within that approved timeframe. The writing and preparation of this article were undertaken only recently. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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