Evaluation of axillary lymph nodes using touch imprint cytology and immunohistochemistry

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Abstract
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.