The value of touch imprint cytology and frozen section for intra-operative evaluation of axillary sentinel lymph nodes

Introduction: Sentinel lymph node (SLN) biopsy is the procedure of choice to determine the axillary involvement in breast cancer. The most important intraoperative evaluation methods are touch imprint cytology (TIC) and frozen section (FS). Each of these techniques has their own drawbacks and it is still unclear which are preferred. Methods: 97 consecutive patients with recently diagnosed breast cancer and no clinical evidence of lymph node involvement were included in the study. The SLN was determined with lymphoscintigraphy.TIC and FS were performed and their results were compared with permanent histopathologic examination. Results: Using permanent section as the gold standard TIC shoed sensitivity of 71.4%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 88.7%. These figures were 87.5%, 98.5%, 96.5%, and 95% for FS respectively. Conclusions: FS is a reliable method for SN involvement during surgery. Using frozen section during surgery can give the surgeon the opportunity to avoid second surgery. TIC is also a reliable method for intra-operative SN evaluation. Due to its high positive predictive value, TIC can be used first in the surgery room and FS can be saved for cases with negative results of TIC