Intraoperative Abklatschzytologie an Wächterlymphknoten beim Mammakarzinom

Die Sentinel-Lymphknoten(SLN)-Biopsie hat in den vergangenen Jahren zunehmende Bedeutung in der Therapie des primären Mammakarzinoms erlangt. Für den Einsatz der Methode in der Praxis ist eine schnelle und zuverlässige intraoperative Untersuchungsmethode der entnommenen SLN essentiell, möchte man di...

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Bibliographic Details
Main Author: Hofmann, Sabine
Contributors: Wagner, Uwe (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2007
Online Access:PDF Full Text
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The sentinel lymphnode (SLN) biopsy has gained rising influence in the treatment of breast cancer over the past years. For it’s use in the routine therapy a fast and intraoperative diagnostic method is essential to decide wether or not a axillary dissection is to be undertaken. This could save patients with axillary metastasis from a second operation. Competing intraoperative methods are the frozen section or the imprint cytology. This study analysed the reliability of imprint cytology in comparison with frozen section analysis and the influence of the particular observer and the staining technique on the results. Therefor imprint cytology was performed on 134 SLN of 64 patients. Used staining techniques were Diff Quick and Papanicolaou. The specimen were analysed by four independent observers with different states of training and expert knowledge. Compared to final histopathology the results of frozen section and imprint cytology, analysed by an experiencered pathologist were equal concerning the sensitivity. However, imprint cytology obtained a lower specificity. The great advantage of imprint cytology whereas is the preservation of lymphnode material by the technique as up to 50% of the lymphnode can be lost by a routine frozen section. The results of imprint cytology showed a strong dependency on the particular observer, but were to a large degree independent of the used staining method. In addition an extensive study of the current literature was performed and a comparison between international and this study’s results was undertaken. It can be concluded that imprint cytology in the hands of an experienced observer is a reliable, fast and tissue conserving technique for the intraoperative analysis of SLN, widely independent of the used staining method. It could be established alone or in combination with frozen sectioning in the routine analysis of SLN. This could save patients with axillary lymphnode metastasis from a second operation for undertaking axillary dissection.