Comparative Study Between Imprint Cytology and Frozen Section Biopsy for Intraoperative Assessment of Sentinel Lymph Node in Breast Cancer
Authors: Noor-E-Alam, Salma Sultana, Mashud Parvez, Swapnil Roy, Mohammad Asad Ullah, Md. Fahimul Islam Mondal, Mohammad Masum, Md. Mehfujul Hassan, Sadia Soruvi, Mir Md. Ashraful Islam
Institution: Dhaka Medical College Hospital and Two Different Private Medical Center
Introduction
Sentinel lymph node (SLN) biopsy is a standard approach for axillary staging in patients with breast carcinoma who have clinically negative lymph nodes. Intraoperative pathology consultation plays a vital role in guiding immediate surgical decisions and reducing the extent of surgery. Accurate intraoperative diagnosis is critical for effective patient management. This study evaluates the sensitivity and specificity of imprint cytology and frozen section techniques for intraoperative SLN assessment in patients with preoperative axilla-negative breast cancer.
Methods
A prospective observational study was conducted on 95 samples from January 2024 to December 2024 at the Department of Surgery, Dhaka Medical College Hospital, and two private medical centers. Patients included were diagnosed with breast carcinoma and negative lymph nodes on preoperative assessment. Data, including demographics, history, clinical examinations, comorbidities, and investigations, were collected and analyzed using IBM SPSS Statistics version 25.
Results
The study analyzed 95 breast cancer cases. Cancer staging revealed 5.25% at Tis, 29.47% at T1, 49.47% at T2, 3.16% at T3, and 12.63% at T4. Infiltrating ductal carcinoma was the predominant histological type (88.42%), followed by ductal carcinoma in situ (5.26%), infiltrating lobular carcinoma (2.10%), and mucinous carcinoma (2.10%). Tumor grades were predominantly grade II (75.79%), followed by grade III (9.47%) and grade I (7.37%). Hormonal receptor status categorized patients as Luminal B (36.84%), Luminal A (29.47%), triple-negative (16.84%), and HER2-enriched (14.74%). Surgical interventions included wide local excision (44.21%), simple mastectomy (27.37%), simple mastectomy with axillary dissection (20.00%), and wide local excision with axillary dissection (8.42%). Diagnostic performance for axillary lymph node metastasis detection showed imprint cytology with 88.46% sensitivity and 95.59% specificity, while frozen section demonstrated 100% sensitivity and 95.59% specificity. The positive predictive value and negative predictive value for imprint cytology were 88.46% and 95.59%, respectively, compared to 90% and 100% for the frozen section.
Conclusion
Both methods demonstrated high specificity; however, imprint cytology was less sensitive than the frozen section in detecting SLN metastases. Due to its simplicity and lower cost, imprint cytology could be considered an alternative to the frozen section.
