Keywords
Sentinel lymph node
Intraoperative evaluation
Metastasis detection
How to Cite
Copyright © | All rights reserved.
The journal holds the exclusive copyright for the publication of this article under the terms of Brazilian law 9610/98.
Partial reproduction
The use of parts of the texts, figures and questionnaire of the article is free, being mandatory the citation of the authors and journal.
Total reproduction
It is expressly prohibited and must be authorized by the journal.
Abstract
Objective: Our study aimed to evaluate the sensitivity and specificity of imprint cytology and frozen section biopsyin detecting mammary lymph node metastases during intraoperative procedures.
Methods: This literature review searched for observational studies in the MEDLINE, LILACS, and SciElo databases, using the descriptors "Breast Cancer," "Sentinel Lymph Nodes," and "Intraoperative Diagnostic Methods," along with their Portuguese and Spanish variants, covering the period from 2000 to 2024. Results: Following application of excluding criteria, 17 studies were eligible for the review, the majority with a quantitative methodology. Frozen section biopsy exhibited higher sensitivity (up to 100%) in detecting macrometastases, whereas imprint cytology showed a sensitivity ranging from 52% to 90%. Both methods demonstrated high specificity, with values approaching 100%. However, both techniques failed in detecting micrometastases and frequently reported false negative results. Final considerations: Frozen section biopsy showed a advantage in terms of sensitivity, particularly for macrometastases. However, imprint cytology remains a suitable option, especially in resource-limited settings. Combining both techniques may enhance diagnostic accuracy and reduce the need for additional surgeries, suggesting the importance of integrated approaches to improve clinical outcomes.
References
ABE M, et al. Prospective Comparison of Intraoperative Touch Imprint Cytology and Frozen Section Histology on Axillary Sentinel Lymph Nodes in Early Breast Cancer Patients.Acta Cytologica, 2020;64:492-497.
AKBAR S, et al. Comparing touch imprint cytology, frozen section analysis, and cytokeratin immunostaining for intraoperative evaluation of axillary sentinel lymph nodes in breast cancer. Indian Journal of Pathology and Microbiology, 2012; 55: 183-186.
AVVAL MM, et al. Comparing scraping cytology with touch imprint cytology and frozen section analysis in the intraoperative diagnosis of sentinel lymph node metastasis in breast cancer.DiagnosticCytopatholog, 2021; 49: 475–479.
BAÑUELOS-ANDRÍO, L, et al. Diagnostic validity of the intraoperative analysis in frozen section of the sentinel lymph node in the surgical management of breast. Revista Española de Medicina Nuclear e Imagen Molecular, 2014; 33: 193-198.
CASTRO CP, et al. Atenção ao câncer de mama a partir da suspeita na atenção primária à saúde nos municípios de São Paulo e Campinas, Brasil. Ciência & Saúde Coletiva [online],2022; 27: 459-470.
CREAGER AJ, et al. Intraoperative Imprint Cytologic Evaluation of Sentinel Lymph Nodes for Lobular Carcinoma of the Breast. Annals of Surgery, 2004; 1: 61-66.
COX C, et al. Accuracy of Intraoperative Imprint Cytology for Sentinel Lymph Node Evaluation in the Treatment of Breast Carcinoma. Cancer (Cancer Cytopathology), 2005;105: 13-20.
FRANCZ M, et al. Intraoperative evaluation of sentinel lymph nodes in breast cancer: comparison of frozen sections, imprint cytology and immunocytochemistry. Cytophatology, 2010; 22: 1-7.
HASHMI AA, et al. Diagnostic Accuracy of Intraoperative Touch Imprint Cytology for the Diagnosis of Axillary Sentinel Lymph Node Metastasis of Breast Cancer: Comparison With Intraoperative Frozen Section Evaluation. Cureus, 2021; 13: n.1: 70-78.
IVKOVIĆ-KAPICL T, et al. Intraoperative imprint cytology of sentinel lymph nodes in breast cancer patients: comparation with frozen section. VojnosanitPregl, 2020; 72: p.196-200.
INSTITUTO NACIONAL DE CÂNCER. INCA. Estimativa 2023: incidência do Câncer no Brasil. Rio de Janeiro: INCA, 2022. Disponível em:Instituto Nacional de Câncer - INCA. Acessadoem: 10 de setembro de 2025.
KHALIFA K, et al. The Accuracy of Intraoperative Frozen Section Analysis of the Sentinel Lymph Nodes During Breast Cancer Surgery. Int J Fertil, 2004; 49: 1-5.
KIMBERLY AV, et al.A Prospective, Blinded Trial of Touch Prep Analysis versus Frozen Section for Intraoperative Evaluation of Sentinel Lymph Nodes in Breast Cancer. Annals of Surgical Oncology, 2008; 15: 2006-2011.
KRISHNAMURTHY S, 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. American cancer society, 2009; 1: 1555-62.
LAI SK, et al. Intraoperative frozen section sentinel lymph node assessment in breast cancer: A tertiaryinstitution experience. Malaysian J Pathol, 2018; 40: 121-128.
LOMBARDI A, et al. Role of frozen section in sentinel lymph node biopsy for breast cancer in the era of the ACOSOG Z0011 and IBGSG 23-10 trials. The surgeon, 2018; 16: 232-236.
LUMACHI F, et al. Touch Imprint Cytology and Frozen-section Analysis for Intraoperative Evaluation of Sentinel Nodes in Early Breast Cancer. Anticancer Research, 2012; 32: 3523-3526.
LU Q, et al. Achieving Breast Cancer Surgery in a Single Setting With Intraoperative Frozen Section Analysis of the Sentinel Lymph Node. Clinical Breast Cancer, 2013; 13: 140-145.
MARANO A, et al.Sentinel lymph node biopsy with intraoperative touch imprint cytology (TIC) in breast cancer:experience of a mild-volume center.G Chir, 2020; 41: 94-98.
MEMAR B, et al. The value of touch imprint cytology and frozen section for intra-operative evaluation of axillary sentinel lymph nodes. Pol J Pathol, 2010; 3: 161-165.
MENDES KDS, et al. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto - Enfermagem, 2008; 17: 758–764.
OUZZANI M, et al.Rayyan — a web and mobile app for systematic reviews. Systematic Reviews, 2016; 5: 1-10.
PAGE MJ, et al. A declaração PRISMA 2020: diretriz atualizada para relatar revisões sistemáticas. Rev Panam Salud Publica, 2022; 46: 1-12.
PETROPOULOU Tet al.Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer. Breast Cancer - Targets and Therapy, 2017; 9: 325–330.
SOUZA MT, et al.Integrative review: what is it? How to do it?.Einstein, 2010; 8: 102–106.
TADA MMK, et al. Frozen section is superior to imprint cytology for the intra-operative assessment of sentinel lymph node metastasis in Stage I Breast cancer patients. World Journal of Surgical Oncology, 2006; 4: 1-17.
TAFFURELLIM. et al. Effectiveness of Sentinel Lymph Node Intraoperative Examination in 753 Women With Breast Cancer: Are We Overtreating Patients?.Annals of Surgery, 2012; 255: 976-980.
TEIXEIRA LA, ARAÚJO NETO LA. Câncer de mama no Brasil: medicina e saúde pública no século XX. Saúde e Sociedade, 2020; 29: 1-11.
URBAN CA, et al. Linfonodo sentinela: um novo conceito no tratamento cirúrgico do câncer de mama. Rev Col Bras Cir[Internet], 2006; 28: 216–22.
WANG YS, et al. Comparative study of one-step nucleic acid amplification assay, frozen section, and touch imprint cytology for intraoperative assessment of breast sentinel lymph node in Chinese patients. Cancer SCI, 2013; 103: 1-5.
YADAV P, et al. Efficacy of intraoperative imprint cytology of sentinel lymph node in breast cancer. CytoJournal, 2024; 21: 1-6.
YI‑CHIN C, CHI‑YUAN T. Intraoperative Sentinel Lymph Node Imprint Cytology Diagnosis in Breast Cancer Patients by General Surgical Pathologists: A Single‑Institution Experience of 4327 Cases. Journal of Cytology, 2022; 39: 20-39.
ZUGMAN M, et al. Comparison of cythopathology and frozen section methods in the intraoperative evaluation of breast sentinel lymph node. J BrasPatol Med Lab, 2017; 53: 276–80.