The Diagnostic Accuracy of an Intraoperative Frozen Section Analysis and Imprint Cytology of Sentinel Node Biopsy Specim
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ORIGINAL ARTICLE
The Diagnostic Accuracy of an Intraoperative Frozen Section Analysis and Imprint Cytology of Sentinel Node Biopsy Specimens from Patients with Uterine Cervical and Endometrial Cancer: a Retrospective Observational Study Tomohito Tanaka 1,2 & Shunsuke Miyamoto 1 & Shinichi Terada 1 & Yuhei Kogata 1 & Satoe Fujiwara 1 & Yoshimichi Tanaka 1 & Kohei Taniguchi 2 & Kazumasa Komura 2 & Kazuhiro Yamamoto 3 & Takashi Yamada 4 & Masahide Ohmichi 1 Received: 1 January 2020 / Accepted: 12 May 2020 # The Author(s) 2020
Abstract Sentinel node biopsy (SNB) may be a decision-making tool for function preservation surgery, including radical trachelectomy and ovary preservation in the treatment of cervical and endometrial cancer. The intraoperative diagnosis is important for guiding treatment decisions for patients with these conditions. Three hundred seventy-one patients with cervical and endometrial cancer received SNB with an intraoperative frozen section analysis and imprint cytology. The sentinel node was cut in half, parallel to the longest axis, to obtain the maximum section area. After performing imprint cytology, one half was used to create a frozen section. The specimen was cut at 2-mm intervals into 5-μm-thick sections, which were subjected to hematoxylin and eosin staining. The diagnostic accuracy of intraoperative frozen section analyses and imprint cytology was compared to the final pathological diagnosis. Among 951 detected sentinel nodes, 51 nodes were found to be positive in the final pathological diagnosis. The sensitivity of a frozen section analysis, imprint cytology and the combination of the two modalities was 76.5%, 72.6%, and 92.2%, respectively. The specificity of a frozen section analysis and imprint cytology was 100%. The negative predictive value of a frozen section analysis and imprint cytology was 98.7% and 98.5%, respectively. In these settings, the accuracy of the frozen section analysis and imprint cytology in the evaluation of SNB specimens was considered acceptable; however, the sensitivity of the combined approach was higher in comparison to when a frozen section analysis or imprint cytology was performed alone. Keywords Endometrial cancer . Cervical cancer . Sentinel node biopsy . Frozen section . Imprint cytology
Introduction The sentinel lymph node (SLN) is the primary lymph node from which cancer cells spread through the lymph * Tomohito Tanaka [email protected] 1
Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
2
Translational Research Program, Osaka Medical College, Takatsuki, Japan
3
Radiology, Osaka Medical College, Takatsuki, Japan
4
Pathology, Osaka Medical College, Takatsuki, Japan
trunk. Cases in which no cancer cells are detected in the SLN are predicted to be free of metastasis at that site. One advantage of sentinel node biopsy (SNB) is that it may reduce the need for systematic lymph node dissection. Moreover, if the SLN status is confirmed during surgery, SNB may be an important dec
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