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A Systematic Review and Meta-analysis of Touch Imprint Cytology and Frozen Section Biopsy and Their Comparison for Evaluation of Sentinel Lymph Node in Breast Cancer

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Abstract

Introduction

Evaluation of axillary lymph nodes after sentinel lymph node biopsy (SLNB) in breast cancer is mostly done by intra-operative frozen section biopsy (FSB) and/ or touch imprint cytology (TIC). In this systematic review and meta-analysis, we have compared the accuracy of the two modalities.

Methods

PubMed, EMBASE, and Cochrane electronic databases were searched for articles comparing TIC with FSB. Articles were assessed for methodological and reporting quality. The main summary measures were pooled sensitivity, pooled specificity, and diagnostic accuracy using bivariate generalized linear mixed models using random effects.

Results

Fourteen studies were included. The pooled sensitivity, specificity, and diagnostic accuracy for FSB were 78%, 100%, and 98.57%. For TIC, the pooled sensitivity, specificity, and diagnostic accuracy were 74%, 98%, and 98.37%. For both methods, visual inspection of summary ROC curves and of forest plots did not show significant heterogeneity.

Conclusion

TIC showed comparable sensitivity, specificity, and accuracy to FSB and hence can be used as its substitute as a rapid and economical test for the detection of axillary lymph node metastasis during SLNB especially in low-resource settings.

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Authors and Affiliations

  1. Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, India

    S. Bharath, Dhananjaya Sharma & Sanjay Kumar Yadav

  2. Department of Preventive and Social Medicine and Biostatistics, Rama Medical College, Kanpur, India

    Saket Shekhar

  3. Department of Surgery, AIIMS, Bihar, Patna, India

    Chandan Kumar Jha

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Contributions

BS contributed to literature search, figures, data collection, data analysis, and data interpretation. DS conceived the present idea and contributed to planning, revision, and editing of manuscript. SKY contributed to literature search, figures, study design, data collection, data analysis, data interpretation, and writing. SS and CKJ contributed to data analysis and interpretation. This is to declare that all authors have contributed to the study. No part of the manuscript has been sent for consideration elsewhere or published in any International or National journal. The authors clearly certify that there is no aspect of plagiarism. All the conflicts of interest have been clearly defined and the source of grant disclosed. Due ethical permission/consent has been obtained for carrying out the study. In case of any dispute, the authors will be held fully responsible for the statement disclosed in the cover letter. The authors are also aware of the copyright rules and also declare that they will not reproduce any published text without due permission from the journal.

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Correspondence to Sanjay Kumar Yadav.

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Bharath, S., Sharma, D., Yadav, S.K. et al. A Systematic Review and Meta-analysis of Touch Imprint Cytology and Frozen Section Biopsy and Their Comparison for Evaluation of Sentinel Lymph Node in Breast Cancer. World J Surg 47, 478–488 (2023). https://doi.org/10.1007/s00268-022-06800-w

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