提高乳腺癌前哨淋巴结冷冻切片制作质量的体会

<正>前哨淋巴结指区域淋巴组织中引流原发肿瘤的第一站淋巴结,是最有可能发生肿瘤转移的淋巴结。早期乳腺癌患者术中行前哨淋巴结快速冷冻切片检查,能较准确地评估其腋窝淋巴结状况,决定是否进行腋窝淋巴结清扫,因此冷冻切片制作质量的好坏直接影响病理诊断的准确率和手术方案的选择。早期乳腺癌腋窝淋巴结转移率低,其前哨淋巴结富含脂肪和淋巴成分,这两种最佳冷冻切片温度截然不同的     

乳腺癌前哨淋巴结术中分子诊断的临床实用性初探

目的 探讨GeneSearchTM乳腺淋巴结检测试剂盒(以下简称GeneSearch)在乳腺癌前哨淋巴结(SLN)术中诊断的临床实用性.方法 对复旦大学附属肿瘤医院2009年2月至6月诊治的88例乳腺癌患者行SLN活检.首先垂直长轴将所得淋巴结切成数块厚约2 mm的组织块,对各切面进行术中细胞印片后,奇数号组织块用于术后连续切片检查,偶数号组织块采用GeneSearch进行检测,应用即时荧光定量逆转录聚合酶链反应检测SLN中CK19和乳腺球蛋白表达的Ct值.将GeneSearch以术后连续切片的诊断为准,与术中细胞印片、术后连续切片的病理结果分别进行比较.结果 88例共获得225枚SLN,其中宏转移淋巴结27枚,微转移淋巴结9枚,阴性淋巴结189枚(其中5枚为孤立肿瘤细胞).从切割淋巴结开始到最终形成报告,GeneSearch耗时范围为35～45 min(平均40 min).基于淋巴结数目,GeneSearch与术后连续切片的总体符合率为95.6%(215/225),其检测敏感度为86.1%(31/36),均高于术中细胞印片[分别为94.7%(213/225)和72.2%(26/36)].SLN转移灶大小与CKl9和乳腺球蛋白的Ct值存在统计学相关性(P＜0.01).结论 GeneSearch用于SLN术中诊断时,其检测敏感度高于术中细胞印片,达到比较满意的效果,但在应用中仍存在一些问题.     

乳腺手术中细胞印片的病理诊断价值

手术中快速病理诊断方法包括冷冻切片、快速石蜡切片和细胞学诊断。由于冷冻切片机设备的不断改进,使冷冻切片质量有了保证,加上具有操作时间短等优点而被广泛应用。快速石蜡切片由于操作步骤较烦琐,时间较长而很少被应用。细胞印片技术操作简单,在更短时间内即可对所送标本做出定性诊断。我们通过对772例术中乳腺标本分别进行细胞印片和冷冻切片检查,并对二者进行比较,探讨细胞印片法在乳腺块中的应用价值。     

影响乳腺癌前哨淋巴结数目的临床病理特征分析

目的分析影响乳腺癌前哨淋巴结数目的相关因素,探讨最佳的前哨淋巴结活检值。方法回顾性分析2007年1月-2011年12月中国医学科学院肿瘤医院乳腺癌前哨淋巴结活检病例578例。采用Logistic回归模型分析前哨淋巴结数目与临床病理特征的相关性。结果全组女性,平均年龄49.9(21～90)岁。总共获得2 222枚前哨淋巴结,平均每例3.8枚(1～15)。淋巴结转移率17.8%(103/578),转移组和无转移组淋巴结数目无差异。单因素分析显示,术式、显像方法和体质指数影响前哨淋巴结数目(P<0.05)。多因素分析中,单纯乳房切除、联合显像、BMI≤30者前哨淋巴结较多(P<0.05)。前哨淋巴结限于5枚时,转移病例检出率100%。18.7%(108/578)病例不必继续送检淋巴结,298枚淋巴结免于切除。结论乳腺癌前哨淋巴结活检数量受到显像方法、乳腺术式和体质指数的影响,5枚前哨淋巴结可能是一个比较合适的参考标准。     

乳腺癌术中腋窝前哨淋巴结细胞学印片快速免疫细胞化学检查的应用价值

目的:探索快速免疫细胞化学技术（RICC）应用于乳腺癌术中腋窝前哨淋巴结（SLN）印片检查的可行性及准确性。方法:收集2020—2021年复旦大学附属肿瘤医院乳腺癌患者术中送检的SLN,大体观察SLN转移情况,同时行细胞学印片（TIC）及RICC检测并分别计数染色操作和阅片时长,RICC检测指标为广谱细胞角蛋白（CKp...     

荧光成像技术联合美蓝在乳腺癌术中探寻前哨淋巴结的应用价值

目的:探讨采用荧光成像技术联合美蓝示踪剂在女性乳腺癌手术治疗中探寻前哨淋巴结的临床应用价值.方法:选取我院收治的150例常规检测为原发性乳腺癌患者,随机分为3组,每组各50例,分别接受联合注射吲哚菁绿(indocyanine green,ICG)及美蓝(联合组)、单独注射ICG(ICG组)和单独注射美蓝(美蓝组)行前哨淋巴结活检手术(sentinel lymph node biopsy,SLNB),后将探寻的前哨淋巴结取出进行冰冻病理检查或常规石蜡病理检查.结果:联合组患者体外淋巴管显影率为94%(47/50),剩余3例有2例为切开后淋巴结显影,淋巴结荧光显影率为92%(46/50).联合组前哨淋巴结(sentinel lymph nodes,SLNs)的总检出率98%(49/50),检出SLNs数量为180枚,其中阳性患者10例(20.41%);ICG组的总检出率为90%(45/50),检出数量为158枚,阳性患者8例(17.78%);美蓝组的总检出率为88%(44/50),检出数量为150枚,阳性患者7例(15.91%);联合组相关观察指标均要优于ICG组和美蓝组.结论:ICG联合美蓝示踪法,相比单独注射ICG或美蓝,能明显提高乳腺癌患者前哨淋巴结的检出率和检出数量,为乳腺癌患者手术方案的选择提供更准确的指导.     

吲哚菁绿在乳腺癌前哨淋巴结活检中的应用

目的探讨吲哚菁绿(ICG)在乳腺癌前哨淋巴结活检(SLNB)中的应用价值。方法对我院2013年1月至2015年12月160例乳腺癌患者进行检测分析,随机分为亚甲蓝组、亚甲蓝联合吲哚菁绿组,分别为65例和95例。比较2组患者的检出成功率、准确率和假阴性率。结果亚甲蓝联合吲哚菁绿组的检出成功率和准确性明显高于亚甲蓝组,差异具有统计学意义(P0.05);亚甲蓝联合吲哚菁绿组的假阴性率明显低于亚甲蓝组,差异具有统计学意义(P0.05);亚甲蓝联合吲哚菁绿组检出的前哨淋巴结(2.9±0.9)枚/例,明显多于亚甲蓝组(1.9±0.5)枚/例,差异具有统计学意义(P0.05);亚甲蓝联合吲哚菁绿组的手术用时明显短于亚甲蓝组。结论吲哚菁绿应用于乳腺癌前哨淋巴结检测可降低其假阴性率,提高乳腺癌的诊断水平。     

印片代冷冻切片472例病理定性诊断分析

基层医院病理科在未开展冷冻切片时,如何配合临床进行手术中快速病理诊断,是目前急需解决的问题。我科自1988年以来应用手术中活体标本做快速印片细胞学定性,为临床提供良、恶性诊断,供确定手术范围做主要参考。其定性准确率在95%以上。在目前缺乏冷冻切片设备的病理科应用是可行的。对已开展冷冻切片的科室可作为协助诊断,纠正部分冷冻切片可能出现的失误。1　材料与方法1.1　材料　标本均选自何贤纪念医院(二级甲等综合性医院、妇幼保健院)病理科1988年11月至1999年11月,快速印片代替冷冻切片,有常规石蜡切片诊断做对照的病例472例。其中…     

印片快速细胞学诊断在术中的应用价值

对200例新鲜标本的印片细胞学快速诊断与冰冻切片诊断及石蜡切片诊断结果进行对照分析,旨在探讨印片法诊断在术中诊断的应用价值。     

常用检查方法对乳腺癌诊断价值的比较研究

目的 :比较电脑近红外线扫描、 B超 ,钼靶 X线摄片和针吸细胞学检查对乳腺癌的诊断价值。方法 :将 6 3位女性乳腺癌患者的电脑近红外线扫描、 B超、钼靶和针吸细胞学检查和病理诊断进行对比。结果 :电脑近红外线扫描、 B超、钼靶和针吸细胞学检查对乳腺癌的诊断准确率分别为 85 .7% ,6 3.1% ,72 .6 %和 83.3%。结论 :电脑近红外线扫描检查简便、无创伤、诊断准确率也较高 ,尤其对早期乳腺癌有较高的诊断价值。联合检查能大大提高诊断准确率。     

Intraoperative evaluation of sentinel lymph nodes in breast carcinoma by imprint cytology,frozen section and rapid immunohistochemistry

Sentinel lymph nodes (SLN) isolated in 40 patients of breast carcinoma (stage T₁/T₂) were evaluated intraoperatively by imprint cytology and frozen section. Rapid immunohistochemistry (IHC) was done in cases where both imprint smears and frozen sections were negative for any metastatic tumor deposits. The results of these different techniques were compared with postoperative paraffin sections taken as “Gold Standard.” Nottingham modification of Bloom Richardson scoring system was used for grading the tumors. Further, the correlation of the SLN status with tumor size, grade, and lymphovascular invasion was studied. The sensitivity, specificity, and overall accuracy of imprint cytology were 91.7, 100, and 95% respectively, and those of the frozen section were 95.8, 100, and 97.5% respectively. Examination of multiple serial sections improved the sensitivity and overall accuracy of frozen section. Results of intraoperative rapid IHC were equivalent to final paraffin sections. Histological grade and lymphovascular invasion were in direct correlation with SLN metastasis (P < 0.05). The risk of lymphovascular invasion increased from 22.2% in grade I tumors to 85.7% in grade III tumors. SLN biopsy is a reliable method to evaluate the status of the axillary lymph nodes. Imprint cytology can be used reliably where the facility of frozen section is not available. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Tissue imprints in surgical pathology: a rapid intraoperative diagnostic aid

We studied the intraoperative diagnostic value of imprint cytology in 230 samples obtained from surgical specimens submitted for frozen section diagnosis. A rapid hematoxylin-eosin stain was used. Intraoperative imprint cytology achieved an accuracy rate of 94.3%; for benign lesions the accuracy was 97.5%, and for malignant lesions it was 91%. Overall, the false-negative and suspicious-for-malignancy rates were 1.3% and 4.3%, respectively. No false-positive results were found. The diagnostic yield when intraoperative imprint cytology and frozen section were used together was 99%. It is apparent that imprint cytology is a quick and simple method with wide applicability in the histopathologic diagnosis of lesions from all organs. The value of the method is enhanced when it is used with frozen section diagnosis.     

Intraoperative evaluation of sentinel lymph nodes for metastatic breast carcinoma by imprint cytology.

BACKGROUND: The increasing utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes attractive. Axillary lymph node dissection can be performed during the initial surgery if the sentinel lymph node is positive, potentially avoiding a second operative procedure. At present the optimal technique for rapid sentinel lymph node assessment has not been determined. Both frozen sectioning and intraoperative imprint cytology are used for rapid intraoperative sentinel lymph node evaluation at many institutions. The purpose of this study is to evaluate experience with imprint cytology for intraoperative evaluation of sentinel lymph nodes in patients with breast cancer. METHODS: A retrospective review of the intraoperative imprint cytology results of 678 sentinel lymph node mappings for breast carcinoma was performed. Sentinel nodes were evaluated intraoperatively by either bisecting or slicing the sentinel node into 4 mm sections. Imprints were made of each cut surface and stained with H&E and/or Diff-Quik. Permanent sections were evaluated with up to four H&E stained levels and cytokeratin immunohistochemistry. Intraoperative imprint cytology results were compared with final histologic results. Results: The sensitivity of imprint cytology was 53%, specificity was 98%, positive predictive value was 94%, negative predictive value was 82% and accuracy was 84%. The sensitivity for detecting macrometastases (more than 2mm) was significantly better than for detecting micrometastases (相似文献   

Intra-operative frozen section technique for breast cancer: end of an era

Data on 2436 primary breast carcinomas diagnosed between 1992 and 2006 were collected to evaluate the rate of frozen section procedures performed over time. Frozen section procedures performed to evaluate resection margins for conservative surgery or sentinel node status were excluded. Over time, there was a decrease in the use of frozen sections indistinctly extended to all pT cancer categories. The rate of cancers diagnosed with frozen sections was 51.2% in 1999, and 0% in 2005-2006. In the same period, the adoption of cytology and core biopsy for breast cancer diagnosis increased from 40% in 1992 to more than 90% since 1999. In an audited diagnostic activity on breast pathology, the routine use of frozen sections on primary lesions was considered inappropriate, particularly in assessment of clinically non-palpable lesions, and should be limited to cases with inadequate pre-surgical sampling.     

Intraoperative sentinel lymph node evaluation in patients with node-positive breast cancer status post neoadjuvant systemic therapy - An institutional experience

Recent studies have shown the feasibility and utility of sentinel lymph node (SLN) biopsy in patients with biopsy proven node-positive breast cancer after neoadjuvant chemotherapy. We reviewed our experience in intraoperative SLN evaluation in such cases and its effect on axillary management. A retrospective analysis of breast cancer patients (2015–2018) with a biopsy-proven positive axillary lymph node, who received neoadjuvant systemic therapy and underwent intraoperative SLN assessment was performed. Intraoperative SLN assessment results were compared with final pathology. Its accuracy and effect on axillary management is summarized. We identified 106 patients with positive axillary lymph node and neoadjuvant systemic therapy between the ages of 28 and 75 years who had SLN biopsy and lumpectomy (33) or mastectomy (73). Three or more SLNs were identified in 91 cases (86 %). The previously biopsied lymph node was identified as one of the sentinel lymph nodes in 93 cases (88 %). There is a high concordance rate between frozen section diagnosis and final diagnosis on sentinel lymph nodes. No false positive case and seven false negative frozen section diagnosis cases (diagnosed as negative on frozen section and positive on permanent sections) were identified. False-negative frozen section diagnosis correlated with low-volume nodal disease and obscuring tumor bed changes. Almost half of the positive lymph nodes were converted to negative after neoadjuvant chemotherapy. SLN biopsy with intraoperative frozen section evaluation after neoadjuvant systemic therapy in node-positive patients is an effective way to minimize axillary surgery.     

Preoperative and intraoperative diagnosis of low-grade adenosquamous carcinoma of the breast: potential diagnostic pitfalls

AIMS: Low-grade adenosquamous carcinoma (LGAC), a rare variant of metaplastic breast cancer, may mimic benign or other low-grade malignant lesions histologically. Diagnostic difficulty may be encountered when evaluating breast cytology, core needle biopsy or intraoperative frozen section specimens. METHODS AND RESULTS: Pathology reports, cytology aspirates and histological slides of LGAC diagnosed at the Department of Pathology, Singapore General Hospital, were reviewed. Four cases of LGAC were analysed. Cytology from the first case showed atypical cells and the subsequent surgical excision specimen showed a complex sclerosing lesion with LGAC. The second and third cases were investigated by core needle biopsies: the preoperative histological features were suggestive of but not diagnostic of LGAC, until further excision biopsies were performed. The fourth case entailed a frozen section specimen, for which definitive diagnosis was deferred to paraffins. The patients remained well with no evidence of recurrent disease to date. CONCLUSIONS: When limited material, in the form of needle aspirates, core biopsy specimens or frozen sections, is submitted for histology, making a diagnosis of LGAC is not only challenging, but may be impossible. In difficult cases, careful pathological assessment, clinicopathological correlation and follow-up or complete excision biopsy may prove invaluable in establishing a definitive diagnosis.     

Role of rapid imprint cytology in the diagnosis of skin cancer and assessment of adequacy of excision.

Imprint cytotechnique was employed in 20 cases of maligant skin tumours (11 squamous cell carcinoma, 4 basal cell carcinoma and 5 malignant melanoma) to evaluate the reliability of the technique by comparing the results with histologic diagnosis. In ten cases margins of the excised tumours were also subjected to imprint and histopathologic studies to assess the clearance of malignancy. All the tumours were correctly diagnosed in imprint smears. Similarly 100% cytohistopathologic correlation was also obtained in the assessment of excisional margins of the tumours. The technique of imprint cytology may be employed for quick diagnosis of skin cancers and in assessment of clearance of surgical field during surgery.     

Use of imprint cytology for assessment of surgical margins in lumpectomy specimens of breast cancer patients

In the past several years, breast-conservation therapy has provided an alternative to mastectomy. In order to reduce the subsequent local tumor recurrence, it is critical that all the measures are in place to find the residual foci of occult microscopic tumor at the time of the initial lumpectomy procedure. An accepted method to evaluate the lumpectomy margins for presence of residual tumor is the use of imprint cytology (also called touch-prep), which is assessment of the presence or absence of the tumor cells by cytological preparation. This is a rapid, cost effective, and easy to use procedure with added advantage of saving tissue for permanent sectioning and rendering a definitive diagnosis. In this report, we present our experience using intraoperative imprint cytology for evaluation of the status of lumpectomy specimens in breast cancer patients. The objective of this study was to evaluate the diagnostic accuracy of intraoperative imprint cytology for assessment of surgical resection margins in lumpectomy margins of patients with breast carcinoma. This is a retrospective study of 100 cases of breast lumpectomy specimens, which had undergone intraoperative imprint cytology. The cases were retrieved from the archived files of the University of Florida, Department of Pathology at Shands Jacksonville. The results of intraoperative imprint cytology were compared with the histological findings of the corresponding permanent sections of the same cases as the gold standard. Overall, we reviewed 510 cytology imprint slides, which were obtained from 100 lumpectomy specimens. Among these cases, 37 slides from 22 cases were reported positive and the remaining were negative. Only eight slides from six cases of lumpectomy showed discrepancy between the result of intraoperative imprint cytology and the permanent sections of the same cases. In our study, intraoperative imprint cytology showed a sensitivity of 97%, specificity of 99%, with positive predictive value of 84%, and negative predictive value of 99%. This study demonstrates that intraoperative imprint cytology can be used as a reliable diagnostic procedure for the evaluation of the status of lumpectomy margins in breast cancer patients.     

Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules.

AIMS: To evaluate the correlation of fine needle aspiration (FNA) cytology and frozen section biopsy in the diagnosis of thyroid nodules. METHODS: The medical records of 662 patients who underwent FNA cytology of the thyroid and thyroid surgery were analysed. Frozen section biopsies were taken from 586 of the 662 patients. The diagnostic correlations of FNA cytology, frozen section, and both FNA cytology and frozen section with definitive histological assessment were evaluated. RESULTS: Among the 662 patients who received FNA cytology, there were 356 cases (53.8%) diagnosed as benign, 114 cases (17.2%) as malignant, 148 cases (22.4%) as indeterminate, and 44 cases (6.6%) as unsatisfactory. The positive predictive value for the detection of malignancy by FNA cytology was 92.1% and the negative predictive value was 95.2%. The incidence of malignancy in the indeterminate cytological diagnosis was 23%. The diagnosis from frozen sections was benign in 445 cases (75.9%), malignant in 134 cases (22.9%), and deferred in 7 cases (1.2%). By frozen section, the positive and negative predictive values were 97% and 95.5%, respectively. Diagnostic accuracy up to 98% was achieved when FNA cytology and frozen section diagnoses were in agreement. No false positives were observed when FNA cytology and frozen sections were both positive for malignancy. When FNA cytology and frozen section diagnoses were discordant, frozen section showed a higher accuracy (78.9%) than FNA cytology (21.1%). In the face of an indeterminate or unsatisfactory cytological diagnosis, the diagnostic accuracy of frozen sections reached 92.6%. CONCLUSIONS: The results confirm that FNA cytology is a useful tool in the initial evaluation of thyroid nodules. Intraoperative frozen section is a valuable procedure to confirm the cytological diagnosis and identify malignancy in patients with indeterminate or unsatisfactory cytological diagnosis. With reliance on frozen sections as an intraoperative guide of thyroid surgery, the possibility of unnecessary extensive surgery and the need for the second operation are considerably lower.     

Intraoperative examination of the sentinel lymph node for breast carcinoma staging.

Intraoperative pathologic examination of the sentinel lymph node (SLN) draining a primary breast carcinoma allows an SLN-positive patient to undergo complete axillary lymphadenectomy as part of the same surgical procedure. However, the optimal technique for rapid SLN assessment has not been determined. We reviewed our results with imprint cytology (IC) and frozen section (FS) examination of SLNs from 278 patients. Compared with H&E-stained paraffin sections, IC and FS had an overall accuracy of 93.2%. The false-reassurance rate (false-negative results/all negative results) was 8.4%. It correctly identified 98% of macrometastases but only 28% of micrometastases. There were no false-positive results. Compared with paraffin-section cytokeratin immunohistochemistry results, the IC-FS false-reassurance rate increased to 25.8%. The false-reassurance rate decreased with smaller primary tumor size (T1 vs T2/3) and ductal type, smaller diameter of the SLN (< or = 2.0 cm), and greater pathologist experience. IC combined with 2-level FS reliably identifies SLN macrometastases but commonly fails to detect SLN micrometastases. If SLN micrometastasis is used to determine the need for further lymphadenectomy, more sensitive intraoperative methods will be needed to avoid a second operation.