AimsOur objective was to evaluate intraoperative sentinel node touch imprint cytology (IOSNTI) for breast cancer. Three hundred and fifty-five patients with invasive breast cancer (pT1 N0, lobular or ductal subtype) were included in our study. IOSNTI consists of touching glass slides to the surfaces of interest after gently pressing the spatially localized specimen, taken according to predetermined conditions, in order to perform a final histological examination consisting of H&E and immunohistochemical staining.ResultsThe total sensitivity (Se) of IOSNTI was 36% and 15% of patients with nodal metastasis went undetected during the intraoperative examination. Sensitivity was significantly lower for the oldest patients (aged over 57 years: 25%), small tumors (smaller than 12 mm: 23.3%), lobular subtypes (8.3%), in the absence of vascular emboli (33%) and for detection of micrometastases (10%).DiscussionThis simple, fast and relatively inexpensive method could be combined with intraoperative molecular biology methods in populations in which cytology is less efficient and produces negative results.

AIMS:Achieving negative margins is essential in conservative treatment for breast cancer. The conventional method for intra-operative assessment of resection margins is gross or histological examination of frozen sections. We describe and evaluate the contribution of an original intra-operative touch preparation cytology (IOTPC) technique (400 procedures) performed on 396 patients.MATERIALS AND METHODS:IOTPC consists of touching glass slides to the surfaces of interest after gently pressing the spatially localized specimen taken according to predetermined conditions. The result is conveyed to the surgeon immediately and compared with the conventional histological findings after embedding in paraffin.RESULTS:The average response time is 10min, which renders the technique compatible with standard operating room procedures and its cost is reasonable. The method has a sensitivity of 88.6%, specificity of 92.2%, positive predictive value of 73.6%, negative predictive value of 97%, and correlation with paraffin section histology of 91.5%. Only 5 true false negatives were found in this series and the technique prevented 11.75% of secondary re-excision procedures for positive margins.CONCLUSION:IOTPC is a reliable extemporaneous method for assessing surgical margins in conservative treatment for breast cancer and a useful tool for surgeons.

11592 Background: To assess the efficacy of intraoperative imprint cytology (IIC) in conservative surgery for early-stage breast cancer. Methods: This is a prospective controlled study led at the Comprehensive Cancer Center of Rennes, France. We reviewed a total of 736 patients who underwent lumpectomy for unifocal breast cancer from January 2004 to December 2005: 400 procedures were finally included. After a standardized surgical procedure, the lumpectomy specimens were intraoperatively oriented by the surgeon and were submitted fresh to pathology for cytologic assessment. The IIC consisted of touching the four faces of interest (superior, inferior, and laterals) onto the glass slide for a cytologic examination. Results: A total of 1,665 separate margins were analyzed. The correlation between IIC and permanent sections was 91.5%. Sensitivity was 88.6%, and specificity was 92.2%. Positive predictive value was 73.6%, and negative predictive value was and 97%. The rate of false positives was significantly increased when the technique used more than four apposition slides (p=0.0019), and when fibrocystic lesions were identified in the lumpectomy (p<0.001). The ductal carcinoma in situ was statistically over-represented among the false negatives (p<0.005), above all when its size was ≥ 30 mm (p<0.005). The intraoperative reexcisions not requested by the pathologist in case of ICC negative were tumor free in 93.9% of cases; conversely there was 71.2% residual tumor when the pathologist requested these reexcisions. The global rate of postoperative reexcisions was 13.25% and IIC avoided a second intervention for 47 patients on the 400 treated (11.75%). Conclusions: Intraoperative imprint cytology is a rapid, simple, reliable and cost-effective method to analyse the margin status of lumpectomy in patient undergoing breast conservative surgery. This technique allows a survey of the entire surface area of the lumpectomy specimen. This method is enable to reduce the number of second operative procedures especially when there is no fibrocystic changes in the breast tissue around the tumor, and when the in situ component of the tumor is limited. No significant financial relationships to disclose.