Intraoperative imprint cytological assessment of the subareolar tissue of the nipple areola complex (NAC) [Intraoperativna procjena tkiva bez mamile primjenom citoloških otisaka]

Tomasović-Lončarić, Čedna and Milanović, Rudolf and Lambaša, Smiljka and Križanac, Šimun and Štoos-Veić, Tajana and Kaić, Gordana and Trutin Ostović, Karmen (2010) Intraoperative imprint cytological assessment of the subareolar tissue of the nipple areola complex (NAC) [Intraoperativna procjena tkiva bez mamile primjenom citoloških otisaka]. Collegium Antropologicum, 34 (2). pp. 431-435. ISSN 0350-6134

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Abstract

One of the criteria of selection for skin sparing mastectomy (SSM) with nipple areola complex (NAC) preservation is to exclude the neoplastic involvement of subareolar tissue (NAC base) in order to minimize the possibility of local recurrence. The most common way to assess the possible neoplastic involvement is intraoperative frozen section of the NAC base tissue. Because of its limitations, particularly the false negative results due to unsampling, we tried to use intraoperative imprint cytology for more thorough intraoperative assessment. The aim was to compare intraoperative imprint findings with the definitive histology of the NAC base, to evaluate diagnostic accuracy of this method and possibility to substitute frozen section for intraoperative assessment of NAC base. A prospective clinical study was conducted of 208 consecutive female patients who underwent open biopsy because of carcinoma. Intraoperative imprints were taken from the excised subareolar tissue which was then routinely processed for definitive histology. Imprint findings designated positive, negative, suspicious or atypia, were compared with definitive histological findings. Our results with 7.5% false negative rate, 9.8% false positive rate, sensitivity of 50% and specificity of 87.58% argue that imprint cytology might not be sufficient as an exclusive method for the intraoperative assessment of the NAC base though it should be used routinely in conjunction with frozen section examination.

Abstract in Croatian

Kako bi se prilikom mastektomije mogla sačuvati koža dojke zajedno s bradavicom, potrebno je isključiti eventualni okultni neoplastični proces u retroareolarnom tkivu radi spriječavanja lokalnog recidiva. Obično se ta histološka procjena radi intraoperativno na zaleđenim rezovima retroareolarnog tkiva tzv baze mamile. Jedno od ograničenja ove metode je nemogućnost pregleda većeg broja uzoraka, prvenstveno zbog vremena, zbog čega se javljaju lažno negativni rezultati. Intraoperativnom primjenom citoloških otisaka pokušali smo u istom vremenu povećati pregledani uzorak. Cilj je bio usporediti nalaze intraoperativnih citoloških otisaka baze mamile s definitivnim patohistološkim nalazima, kako bi procjenili vrijednost ove metode za intraoperativni pregled baze mamile i da li može zamijeniti zaleđene rezove pri intraoperativnom pregledu. U ovoj prospektivnoj studiji pregledano je retroareolarno tkivo u 208 konsekutivnih intraoperativnih biopsija carcinoma dojke. Nakon intraoperativnog uzimanja otisaka retroareolarno tkivo se u cijelosti preuzelo, uobičajeno obradilo i uklopilo za trajne parafinske rezove. Citološki nalazi otisaka, označeni kao pozitivni, negativni, suspektni i atipični, zatim su uspoređeni s patohistološkim nalazima pregledanih parafinskih rezova baza mamila. Usporedbom nađeno je 7,5% lažno negativnih citoloških nalaza, 9,8% lažno pozitivnih nalaza, pri čemu je senzitivnost bila 50% a specifičnost 87,58%. Iako prema ovim rezultatima izgleda da citološki otisci nisu dostatni za intraoperativnu procjenu baze mamile smatramo da ih treba koristiti kao rutinsku, korisnu nadopunu zaleđenim rezovima.

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