Role of Imprint Cytology in Intraoperative Pathological Diagnosis.

Balamurugan, S G (2006) Role of Imprint Cytology in Intraoperative Pathological Diagnosis. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION : The development of the concept of intraoperative evaluation of tissue diagnosis had revolutionary effect in the field of surgical oncology. Intraoperative tissue diagnosis helps cancer surgeon : 1. To confirm pathological diagnosis when pre-operative diagnosis is inconclusive. 2. To decide about the extent of the surgery :a. To avoid nodal dissection when sentinel node of nodal basin is negative and to complete nodal dissection when sentinel node is positive b. To assess the marginal status after excision and help to achieve margin free excisions 3. To avoid the major ablative surgeries when, tumor has metastasized beyond a proposed resection. 4. To decide the definitive procedure after needle localization biopsy in suspected Ca. Breast.Currently intra operative evaluation is performed using, 1. Frozen section, 2. Imprint cytology, 3. Immuno Histo Chemistry, 4. Molecular study - R.T PCR.Touch imprint cytology is simple, quick and inexpensive and can be done even in centers where only basic pathology facility is available. Secondly the low cost and rapidity of this procedure is a big boon to the community based hospitals.Imprint cytodiagnosis is a relatively new technique that was introduced by Dudgeon & Patrick from UK and subsequently tried by several others in the last decade. The technique is relatively simple, cheap, reliable and does not require elaborate apparatus. The time required for imprinting a slide, staining and obtaining a readable result is only 6-8 minutes. Thus it is suggested, that in places where frozen section facilities are not available, imprint cytodiagnosis would be a valuable alternative. The mean accuracy rate for imprint cytology is 91% with range from 78% to 98% in various literatures. AIM : The aim of the present study is to evaluate our institutional experience with touch imprint cytology and to ascertain the reliability of touch imprint cytology as an intraoperative diagnostic tool in determining the histologic status of suspicious lymph nodes for metastasis and there by determining its sensitivity, accuracy, predictive value and its feasibility in our institution to aid the surgical oncologic procedures. However the present study is designed to assess the value of touch imprint cytodiagnosis in solid tumors by extrapolating its rich sentinel node experience from the many well-known studies. CONCLUSION : The results of the current study demonstrate that the accuracy of Imprint cytology is high enough to warrant its use for Intraoperative pathological assessment. It can be accomplished during primary surgery and does not appear to prolong the surgical procedure significantly. The efficacy of the method is good. The main limitation of such an approach is an obviously low sensitivity for the detection of micro metastases. From the above discussion, it is clear that many gaps remain in our knowledge of optimal pathologic analysis of nodal metastases, but some tentative general conclusions can be drawn – which may be invalidated by subsequent, more definitive studies. Intraoperative pathologic assessment of nodal status should be a joint decision between the surgeon and the pathologist, based on the likelihood of metastases and the relative risks and benefits to the patient in a given case. Intraoperative cytological Touch imprint on bisected nodes is areasonable approach to identify at least a proportion of the larger metastases, without wasting significant lymph node tissue. It should be understood that micro metastases are unlikely to be detected by this method, however.Imprint cytology is a viable alternative to traditional frozen section when intraoperative evaluation is required. Given its 96.67% specificity surgeon may feel confident in basing their Intraoperative decision on touch imprint cytology results. Clearly, Imprint cytology evaluation of lymph nodal status lacks sufficient sensitivity to serve as the final diagnostic test. Further evaluation of permanent sections using traditional techniques such as H & E still remains the gold standard and is indicated.Despite the simplicity, speed and excellent cellular detail the technique has still not been fully utilized. We advocate the consideration of Touch imprint cytodiagnosis for the evaluation of cases with nodal metastases as a valuable alternative to frozen section histology.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Imprint Cytology ; Intraoperative Pathological Diagnosis.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Kambaraman B
Date Deposited: 25 Jul 2017 02:53
Last Modified: 25 Jul 2017 02:53

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