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Comparison of Diagnostic Accuracy of Frozen Section with Imprint Cytology for Intraoperative Examination of Sentinel Lymph Node in Early-Stage Endometrial Cancer: Results of Senti-Endo Study

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

Abstract

Background

In early-stage endometrial cancer, intraoperative examination of sentinel lymph nodes (SLNs) can predict nodal involvement and avoid a second surgical procedure. Our goal was to determine the diagnostic accuracy (DA) of intraoperative examination in diagnosing metastatic pelvic SLNs.

Methods

This was a retrospective study, including 125 patients with early stage endometrial cancer. Results of intraoperative examination by frozen section (FS) or imprint cytology (IC) were compared with final histology (serial sectioning and immunohistochemistry (IHC)). The diagnostic value of intraoperative examination was calculated.

Results

Of the 111 patients with SLNs detected (89 %), 87 (78.5 %) had an intraoperative examination (30 with FS and 57 with IC). Intraoperative examination detected SLN metastases in 9 of 16 patients with metastatic SLN at definitive histology (sensitivity = 56.3 %): macrometastasis in 8 and micrometastasis in 1. Seven false-negative cases were found (43.7 %; micrometastases in 6 and isolated tumor cells in 1). The DA of intraoperative examination was 92 % (95 % confidence interval (CI), 84–96.7). For FS and IC, DA was 97.3 % (95 % CI, 85.8–99.9) and 88 % (95 % CI, 75.7–95.5), respectively.

Conclusions

FS has better DA than IC for intraoperative examination of SLNs in endometrial cancer. The main limitation of both techniques is in detecting micrometastasis and isolated tumor cells.

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References

  1. Selman TJ, Mann CH, Zamora J, Khan KS. A systematic review of tests for lymph node status in primary endometrial cancer. BMC Womens Health. 2008;8:8.

    Article  PubMed  Google Scholar 

  2. Ballester M, Dubernard G, Lecuru F, et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011;12:469–76.

    Article  PubMed  Google Scholar 

  3. Ballester M, Dubernard G, Rouzier R, Barranger E, Darai E. Use of the sentinel node procedure to stage endometrial cancer. Ann Surg Oncol. 15:1523–9.

  4. Bats AS, Clement D, Larousserie F, et al. Does sentinel node biopsy improve the management of endometrial cancer? Data from 43 patients. J Surg Oncol. 2008;97:141–5.

    Article  PubMed  Google Scholar 

  5. Bats AS, Clement D, Larousserie F, et al. Is sentinel node biopsy feasible in endometrial cancer? Results in 26 patients. J Gynecol Obstet Biol Reprod. 2005;34:768–74.

    Article  Google Scholar 

  6. Delaloye JF, Pampallona S, Chardonnens E, et al. Intraoperative lymphatic mapping and sentinel node biopsy using hysteroscopy in patients with endometrial cancer. Gynecol Oncol. 2007;106:89–93.

    Article  PubMed  Google Scholar 

  7. Delpech Y, Cortez A, Coutant C, et al. The sentinel node concept in endometrial cancer: histopathologic validation by serial section and immunohistochemistry. Ann Oncol. 18:1799–803.

  8. Delpech Y, Coutant C, Morel O, Uzan S, Darai E, Barranger E. Value of sentinel lymph node procedure in endometrial cancer. Gynecol Obstet Fertil. 2007;35:618–24.

    Article  PubMed  CAS  Google Scholar 

  9. Fersis N, Gruber I, Relakis K, et al. Sentinel node identification and intraoperative lymphatic mapping. First results of a pilot study in patients with endometrial cancer. Eur J Gynaecol Oncol. 2004;25:339–42.

    PubMed  CAS  Google Scholar 

  10. Frumovitz M, Bodurka DC, Broaddus RR, et al. Lymphatic mapping and sentinel node biopsy in women with high-risk endometrial cancer. Gynecol Oncol. 2007;104:100–3.

    Article  PubMed  Google Scholar 

  11. Barlin JN, Khoury-Collado F, Kim CH, et al. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol. 2012 Feb 22 [Epub ahead of print].

  12. Kang S, Yoo HJ, Hwang JH, Lim MC, Seo SS, Park SY. Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies. Gynecol Oncol. 2011;123:522–7.

    Article  PubMed  Google Scholar 

  13. Khoury-Collado F, Murray MP, Hensley ML, et al. Sentinel lymph node mapping for endometrial cancer improves the detection of metastatic disease to regional lymph nodes. Gynecol Oncol. 2011;122:251–4.

    Article  PubMed  CAS  Google Scholar 

  14. Mais V, Peiretti M, Gargiulo T, Parodo G, Cirronis MG, Melis GB. Intraoperative sentinel lymph node detection by vital dye through laparoscopy or laparotomy in early endometrial cancer. J Surg Oncol. 2010;101:408–12.

    PubMed  Google Scholar 

  15. Khoury-Collado F, Glaser GE, Zivanovic O, et al. Improving sentinel lymph node detection rates in endometrial cancer: how many cases are needed? Gynecol Oncol. 2009;115:453–5.

    Article  PubMed  Google Scholar 

  16. Oonk MH, van de Nieuwenhof HP, de Hullu JA, van der Zee AG. The role of sentinel node biopsy in gynecological cancer: a review. Curr Opin Oncol. 2009;21:425–32.

    Article  PubMed  Google Scholar 

  17. Altgassen C, Müller N, Hornemann A, et al. Immunohistochemical workup of sentinel nodes in endometrial cancer improves diagnostic accuracy. Gynecol Oncol. 2009;114:284–7.

    Article  PubMed  Google Scholar 

  18. Robova H, Charvat M, Strnad P, et al. Lymphatic mapping in endometrial cancer: comparison of hysteroscopic and subserosal injection and the distribution of sentinel lymph nodes. Int J Gynecol Cancer. 2009;19:391–4.

    Article  PubMed  Google Scholar 

  19. Abu-Rustum NR, Khoury-Collado F, Pandit-Taskar N, et al. Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma? Gynecol Oncol. 2009;113:163–9.

    Article  PubMed  Google Scholar 

  20. Francz M, Egervari K, Szollosi Z. Intraoperative evaluation of sentinel lymph nodes in breast cancer: comparison of frozen sections, imprint cytology and immunocytochemistry. Cytopathology. 2011;22:36–42.

    Article  PubMed  CAS  Google Scholar 

  21. Pristauz G, Bader AA, Regitnig P, Haas J, Winter R, Tamussino K. How accurate is frozen section histology of pelvic lymph nodes in patients with endometrial cancer? Gynecol Oncol. 2009;115:12–7.

    Article  PubMed  Google Scholar 

  22. Mikuta JJ. International Federation of Gynecology and Obstetrics staging of endometrial cancer 1988. Cancer. 1993;71:1460–3.

    Article  PubMed  CAS  Google Scholar 

  23. Marnitz S, Kohler C, Bongardt S, Braig U, Hertel H, Schneider A. Topographic distribution of sentinel lymph nodes in patients with cervical cancer. Gynecol Oncol. 2006;103:35–44.

    Article  PubMed  Google Scholar 

  24. Singletary SE, Allred C, Ashley P, et al. Revision of the American Joint Committee on cancer staging system for breast cancer. J Clin Oncol. 2002; 20:3628–36.

    Article  PubMed  Google Scholar 

  25. Upender S, Mohan H, Handa U, Attri AK. Intraoperative evaluation of sentinel lymph nodes in breast carcinoma by imprint cytology, frozen section and rapid immunohistochemistry. Diagn Cytopathol. 2009;37:871–5.

    Article  PubMed  Google Scholar 

  26. Komenaka IK, Torabi R, Nair G, et al. Intraoperative touch imprint and frozen section analysis of sentinel lymph nodes after neoadjuvant chemotherapy for breast cancer. Ann Surg. 2010;251:319–22.

    Article  PubMed  Google Scholar 

  27. Bats AS, Buenerd A, Querleu D, et al. Diagnostic value of intraoperative examination of sentinel lymph node in early cervical cancer: a prospective, multicenter study. Gynecol Oncol. 2011;123:230–5.

    Article  PubMed  Google Scholar 

  28. Van der Zee AG, Oonk MH, De Hullu JA, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol. 2008;26:884–9.

    Article  PubMed  Google Scholar 

  29. Tew K, Irwig L, Matthews A, Crowe P, Macaskill P. Meta-analysis of sentinel node imprint cytology in breast cancer. Br J Surg. 2005;92:1068–80.

    Article  PubMed  CAS  Google Scholar 

  30. Brogi E, Torres-Matundan E, Tan LK, Cody HS III. The results of frozen section, touch preparation, and cytological smear are comparable for intraoperative examination of sentinel lymph nodes: a study in 133 breast cancer patients. Ann Surg Oncol. 2005;12:173–80.

    Article  PubMed  Google Scholar 

  31. Cox C, Centeno B, Dickson D, et al. Accuracy of intraoperative imprint cytology for sentinel lymph node evaluation in the treatment of breast carcinoma. Cancer. 2005;105:13–20.

    Article  PubMed  Google Scholar 

  32. Menes TS, Tartter PI, Mizrachi H, Smith SR, Estabrook A. Touch preparation or frozen section for intraoperative detection of sentinel lymph node metastases from breast cancer. Ann Surg Oncol. 2003;10:1166–70.

    Article  PubMed  Google Scholar 

  33. Motomura K, Nagumo S, Komoike Y, Koyama H, Inaji H. Intraoperative imprint cytology for the diagnosis of sentinel node metastases in breast cancer. Breast Cancer (Tokyo, Japan). 2007;14:350–3.

    Google Scholar 

  34. Pogacnik A, Klopcic U, Grazio-Frkovic S, Zgajnar J, Hocevar M, Vidergar-Kralj B. The reliability and accuracy of intraoperative imprint cytology of sentinel lymph nodes in breast cancer. Cytopathology. 2005;16:71–6.

    Article  PubMed  CAS  Google Scholar 

  35. Pugliese MS, Tickman R, Wang NP, Atwood M, Beatty JD. The utility of intraoperative evaluation of sentinel lymph nodes in breast cancer. Ann Surg Oncol. 2007;14:1024–30.

    Article  PubMed  Google Scholar 

  36. Richter T, Nahrig J, Komminoth P, Kowolik J, Werner M. Protocol for ultrarapid immunostaining of frozen sections. J Clin Pathol. 1999;52:461–3.

    Article  PubMed  CAS  Google Scholar 

  37. Van Diest PJ, Torrenga H, Borgstein PJ, et al. Reliability of intraoperative frozen section and imprint cytological investigation of sentinel lymph nodes in breast cancer. Histopathology. 1999;35:14–8.

    Article  PubMed  Google Scholar 

  38. Krishnamurthy S, Meric-Bernstam F, Lucci A, et al. A prospective study comparing touch imprint cytology, frozen section analysis, and rapid cytokeratin immunostain for intraoperative evaluation of axillary sentinel lymph nodes in breast cancer. Cancer. 2009;115:1555–62.

    Article  PubMed  Google Scholar 

  39. Aihara T, Munakata S, Morino H, Takatsuka Y. Touch imprint cytology and immunohistochemistry for the assessment of sentinel lymph nodes in patients with breast cancer. Eur J Surg Oncol. 2003;29:845–8.

    Article  PubMed  CAS  Google Scholar 

  40. Johnston EI, Beach RA, Waldrop SM, Lawson D, Cohen C. Rapid intraoperative immunohistochemical evaluation of sentinel lymph nodes for metastatic breast carcinoma. Appl Immunohistochem Mol Morphol. 2006;14:57–62.

    Article  PubMed  Google Scholar 

  41. Khalifa K, Pereira B, Thomas VA, Mokbel K. The accuracy of intraoperative frozen section analysis of the sentinel lymph nodes during breast cancer surgery. Int J Fertil Womens Med. 2004;49:208–11.

    PubMed  CAS  Google Scholar 

  42. Nahrig JM, Richter T, Kuhn W, et al. Intraoperative examination of sentinel lymph nodes by ultrarapid immunohistochemistry. Breast J. 2003;9:277–81.

    Article  PubMed  Google Scholar 

  43. Salem AA, Douglas-Jones AG, Sweetland HM, Mansel RE. Intraoperative evaluation of axillary sentinel lymph nodes using touch imprint cytology and immunohistochemistry: I. Protocol of rapid immunostaining of touch imprints. Eur J Surg Oncol. 2003;29:25–8.

    Article  PubMed  CAS  Google Scholar 

  44. Salem AA, Douglas-Jones AG, Sweetland HM, Mansel RE. Intraoperative evaluation of axillary sentinel lymph nodes using touch imprint cytology and immunohistochemistry. Part II. Results. Eur J Surg Oncol. 2006;32:484–7.

    Article  PubMed  CAS  Google Scholar 

  45. Weinberg ES, Dickson D, White L, et al. Cytokeratin staining for intraoperative evaluation of sentinel lymph nodes in patients with invasive lobular carcinoma. Am J Surg. 2004;188:419–22.

    Article  PubMed  CAS  Google Scholar 

  46. Giuliano AE, Dale PS, Turner RR, Morton DL, Evans SW, Krasne DL. Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg. 1995;222:394–9; discussion 399–401.

    Google Scholar 

  47. Veronesi U, Paganelli G, Viale G, et al. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst. 1999;91:368–73.

    Article  PubMed  CAS  Google Scholar 

  48. Chan JK, Cheung MK, Huh WK, et al. Therapeutic role of lymph node resection in endometrioid corpus cancer: a study of 12,333 patients. Cancer. 2006;107:1823–30.

    Article  PubMed  Google Scholar 

  49. Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet. 2010;375:1165–72.

    Article  PubMed  Google Scholar 

  50. Lecuru F, Mathevet P, Querleu D, et al. Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol. 2011;29:1686–91.

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Tenon University Hospital, Paris, France

    Marcos Ballester MD, Roman Rouzier MD, PhD & Emile Daraï MD, PhD

  2. Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, France

    Gil Dubernard MD, PhD

  3. Department of Gynecology, Georges Pompidou University Hospital, Paris, France

    Anne-Sophie Bats MD, PhD

  4. Department of Gynecology, Poissy-Saint Germain en Laye University Hospital, Poissy, France

    Denis Heitz MD

  5. Department of Obstetrics and Gynecology, Edouard Herriot University Hospital, Lyon, France

    Patrice Mathevet MD, PhD

  6. Department of Obstetrics and Gynecology, Bretonneau University Hospital, Tours, France

    Henri Marret MD

  7. Department of Surgical Oncology, Claudius Regaud Comprehensive Cancer Center, Toulouse, France

    Denis Querleu MD

  8. Department of Obstetrics and Gynecology, Centre Hospitalier Lyon Sud, Lyon, France

    François Golfier MD, PhD

  9. Department of Surgical Oncology, Centre Oscar Lambret, Lille, France

    Eric Leblanc MD

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  1. Marcos Ballester MD
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Correspondence to Marcos Ballester MD.

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Ballester, M., Dubernard, G., Bats, AS. et al. Comparison of Diagnostic Accuracy of Frozen Section with Imprint Cytology for Intraoperative Examination of Sentinel Lymph Node in Early-Stage Endometrial Cancer: Results of Senti-Endo Study. Ann Surg Oncol 19, 3515–3521 (2012). https://doi.org/10.1245/s10434-012-2390-7

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  • DOI: https://doi.org/10.1245/s10434-012-2390-7

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