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Intraoperative Touch Imprint Cytology in Targeted Axillary Dissection After Neoadjuvant Chemotherapy for Breast Cancer Patients with Initial Axillary Metastasis

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

For breast cancer patients, a false-negative rate lower than 10% can be achieved if targeted axillary dissection (TAD) is performed, which includes the excision of both biopsy-proven positive lymph nodes (BxLNs) and sentinel lymph nodes (SLNs). However, little evidence exists on the accuracy of intraoperative touch imprint cytology (ITPC) applied in TAD after neoadjuvant chemotherapy (NAC) for breast cancer patients with initial axillary metastasis. This study aimed to investigate the accuracy of ITPC in TAD after NAC.

Methods

Breast cancer patients with biopsy-confirmed nodal metastasis were prospectively enrolled in the study. After completion of NAC, all patients underwent TAD followed by axillary lymph node dissection (ALND). Then ITPC was performed to evaluate BxLNs and SLNs. The accuracy of TAD and ITPC was calculated in comparison with hematoxylin and eosin (H&E) staining of ALNs. The results of ITPC during 6 months at our center in the adjuvant setting were used for comparison .

Results

Overall, the false-negative rate of TAD was 10.8%. In a test with 92 patients, ITPC had an accuracy of 92.4%, a sensitivity of 87.9%, and a specificity of 94.9%. In the non-NAC group, ITPC showed similar accuracy (91.2%) and specificity (97.9%) but significantly lower sensitivity (68.9%; P = 0.03).

Conclusions

The use of ITPC was feasible for TAD among breast cancer patients with biopsy-confirmed axillary metastasis who were treated with NAC. All the misses in the ITPC involved patients with micrometastases or isolated tumor cells. Use of ITPC can help decrease the number of second operations for patients with residual disease in ALNs after NAC.

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Acknowledgments

The authors thank all participating patients and clinicians for contributing data to this study.

Author information

Author notes

  1. Siyu Wu, Yujie Wang, Na Zhang and Jianwei Li contributed equally to this study.

Authors and Affiliations

  1. Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, People’s Republic of China

    Siyu Wu MD, Yujie Wang MD, Na Zhang MD, Jianwei Li MD, Juping Shen MD & Guangyu Liu MD

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China

    Siyu Wu MD, Yujie Wang MD, Na Zhang MD, Jianwei Li MD, Xiaoli Xu MD, Juping Shen MD & Guangyu Liu MD

  3. Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China

    Xiaoli Xu MD

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  1. Siyu Wu MD
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Correspondence to Guangyu Liu MD.

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Fig. S1

Touch imprints of a positive biopsied lymph node during (A) targeted axillary dissection (TAD) and (B) sentinel lymph node biopsy (SLNB) alone (hematoxylin and eosin staining) (TIFF 6093 kb)

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Wu, S., Wang, Y., Zhang, N. et al. Intraoperative Touch Imprint Cytology in Targeted Axillary Dissection After Neoadjuvant Chemotherapy for Breast Cancer Patients with Initial Axillary Metastasis. Ann Surg Oncol 25, 3150–3157 (2018). https://doi.org/10.1245/s10434-018-6548-9

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  • DOI: https://doi.org/10.1245/s10434-018-6548-9

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