K Tew1, L Irwig, A Matthews, P Crowe, P Macaskill. 1. Breast/Endocrine Surgery and Surgical Oncology Unit, Prince of Wales Hospital, Randwick, Australia. kltew@hotmail.com
Abstract
BACKGROUND: Intraoperative diagnosis of breast cancer metastases in axillary sentinel nodes is desirable to avoid a second operation for lymphadenectomy. Imprint or touch-preparation cytology is a popular technique that has high specificity and a wide range of sensitivity. METHODS: A systematic search of electronic databases was performed. Included articles were assessed for methodological and reporting quality. Random-effects model pooled estimates of sensitivity and specificity were calculated. Single-variable and multivariable meta-regression analyses were performed for predictors of sensitivity. RESULTS: Thirty-one studies were included; all were of good methodological quality but reporting quality varied. Pooled sensitivity of imprint cytology was 63 (95 per cent confidence interval (c.i.) 57 to 69) per cent and specificity was 99 (95 per cent c.i. 98 to 99) per cent. Pooled sensitivity for macrometastases was 81 per cent and that for micrometastases 22 per cent. Mean or median primary tumour size (P = 0.004), the prevalence of metastases (P = 0.103) and the proportion of micrometastases (P = 0.022) were significant risk factors in single-variable meta-regression analysis. Only the proportion of micrometastases remained significant in multivariable analysis. Frozen sectioning had better sensitivity than imprint cytology in three of four direct comparisons. CONCLUSION: Imprint cytology is simple and rapid, and has good sensitivity for macrometastases. The significance of poor sensitivity for micrometastases will be determined by trials investigating their natural history. Copyright 2005 British Journal of Surgery Society Ltd.
BACKGROUND: Intraoperative diagnosis of breast cancer metastases in axillary sentinel nodes is desirable to avoid a second operation for lymphadenectomy. Imprint or touch-preparation cytology is a popular technique that has high specificity and a wide range of sensitivity. METHODS: A systematic search of electronic databases was performed. Included articles were assessed for methodological and reporting quality. Random-effects model pooled estimates of sensitivity and specificity were calculated. Single-variable and multivariable meta-regression analyses were performed for predictors of sensitivity. RESULTS: Thirty-one studies were included; all were of good methodological quality but reporting quality varied. Pooled sensitivity of imprint cytology was 63 (95 per cent confidence interval (c.i.) 57 to 69) per cent and specificity was 99 (95 per cent c.i. 98 to 99) per cent. Pooled sensitivity for macrometastases was 81 per cent and that for micrometastases 22 per cent. Mean or median primary tumour size (P = 0.004), the prevalence of metastases (P = 0.103) and the proportion of micrometastases (P = 0.022) were significant risk factors in single-variable meta-regression analysis. Only the proportion of micrometastases remained significant in multivariable analysis. Frozen sectioning had better sensitivity than imprint cytology in three of four direct comparisons. CONCLUSION: Imprint cytology is simple and rapid, and has good sensitivity for macrometastases. The significance of poor sensitivity for micrometastases will be determined by trials investigating their natural history. Copyright 2005 British Journal of Surgery Society Ltd.
Authors: Martin R Austwick; Benjamin Clark; Charles A Mosse; Kristie Johnson; D Wayne Chicken; Santosh K Somasundaram; Katherine W Calabro; Ying Zhu; Mary Falzon; Gabrijela Kocjan; Tom Fearn; Stephen G Bown; Irving J Bigio; Mohammed R S Keshtgar Journal: J Biomed Opt Date: 2010 Jul-Aug Impact factor: 3.170
Authors: V M Pérez-Sánchez; T A Vela-Chávez; P Villarreal-Colin; E Bargalló-Rocha; M T Ramírez-Ugalde; D Munoz-Gonzalez; I Zeichner-Gancz Journal: Med Oncol Date: 2009-03-19 Impact factor: 3.064
Authors: Thorsten Heilmann; Micaela Mathiak; Jakob Hofmann; Christoph Mundhenke; Marion van Mackelenbergh; Ibrahim Alkatout; Antonia Wenners; Christel Eckmann-Scholz; Christian Schem Journal: J Cancer Res Clin Oncol Date: 2013-08-02 Impact factor: 4.553
Authors: Dayalan Clarke; Edmund Leung; Naresh Chachlani; David Rowlands; Jayanthi Simon; Isabel Hero; David England Journal: World J Surg Date: 2010-01 Impact factor: 3.352
Authors: Catherine E Loveland-Jones; Karen Ruth; Elin R Sigurdson; Brian L Egleston; Marcia Boraas; Richard J Bleicher Journal: Breast Cancer Res Treat Date: 2014-01-19 Impact factor: 4.872