6.  BRIEF RESUME OF THE INTENDED WORK :

6.1  NEED FOR THE STUDY:

Breast operations are most commonly encountered in general surgical practice and it is important to have an intraoperative diagnosis since the pathology of lesion influences the management modality.

Imprint cytology is a quick, reliable, simple and cost effective intraoperative diagnostic tool which is specially helpful in set-ups where facilities for frozen section are not available. The method does not require any specialized equipment and is less time consuming. The method offers additional advantages over frozen section in that freezing artifacts of the tissue and serial sectioning are avoided.

Intraoperative cytology of imprint smears is a very valuable tool in determining the precise area of surgical extirpation of tumors. In addition, it can sometimes provide information on histiogenesis and histological pattern of the tumors.

6.2  REVIEW OF LITERATURE:

In a study of 351 cases of breast lesions (180 benign and 171 malignant) by imprint cytology, fine needle aspiration biopsy and histology for diagnosis of breast malignancy, imprint cytology as compared to histology had 98.3% accuracy with 97.1% sensitivity and 99.4% specificity. Aspiration cytology was less accurate with 94.9% accuracy, 93.9% sensitivity and 96.2% specificity. The authors opined that imprint cytology could be used intraoperatively as an effective alternative to frozen section if a pathology laboratory is not available.

In a study of 31 cases of breast masses the accuracy of fine needle aspiration cytology, intraoperative imprint cytology and frozen section was compared to paraffin section diagnosis. The sensitivity of FNAC, imprint cytology and frozen section for the diagnosis of breast malignancy was 82.6%, 95.8% and 91.7% respectively. All the three had 100% specificity and 0% false positive rates. A 100% diagnostic accuracy was achieved by combined FNAC and imprint cytology. The authors concluded that the intraoperative imprint cytology improves the diagnostic accuracy of FNAC and frozen section in breast lesions.

In another study, cases undergoing breast conservation therapy were investigated by imprint cytology and the authors opined that imprint method is a rapid technique for evaluating surgical margins intraoperatively, thus allowing complete excision to be performed during the initial surgery.

In another prospective study imprint cytology was carried out on 799 breast masses at the surgical operation theatre. Among 799 cases, 496 (62.07%) were benign lesions and 303 (37.93%) were malignant. The accuracy of imprint cytology was 96.7% with 3.3% of false negatives and no false positives.

In a study of 40 cases of breast tumours by imprint cytology 21 were malignant and 19 were benign. The accuracy rate for malignant lesions was 97.5% and that for benign lesions was 100%. The sensitivity and specificity were 95.24% and 100% respectively.

In another study imprint cytology method was applied on microcalcifications excised by Vacuum-assisted breast biopsy (VABB). A total of 93 women with microcalcifications underwent VABB and imprint smears of these excisions were examined. Of these, 73 lesions were benign,15 malignant and 5 were precursors. The observed sensitivity and specificity of the cytological imprints for cancers were 100%. It was concluded that the imprint cytology provided a rapid and accurate preliminary diagnosis of early breast cancers within few minutes and possibly attenuated patient’s anxiety.

6.3  OBJECTIVES OF THE STUDY

1.  To adopt imprint cytology in intraoperative assessment of breast neoplasms in order to facilitate decision regarding extent of surgery to be performed.

2.  To assess efficacy of intraoperative imprint cytology by correlation with

histopathological diagnosis.

7 MATERIALS AND METHODS:

7.1  SOURCE OF DATA :

Patients with clinically diagnosed breast lumps from K.R.Hospital referred to the department of Pathology and subsequently confirmed as breast neoplasms by fine needle aspiration cytology and posted for surgery form the basis for the study.

Sample size : 50 cases.

Duration of study : 18 months.

7.2  METHODS OF COLLECTION OF DATA :

Imprint cytology shall be done intraoperatively under the guidance of the operating surgeon at K.R.Hospital after obtaining informed consent from the patient under absolute aseptic precautions by the pathologist. Imprint smears shall be prepared from the cut surface of freshly dissected breast specimen by touching glass slides on the surface, focussing on suspicious looking areas. The smears shall be immediately wet fixed in 95% Alcohol stained by

Hematoxylin & Eosin and Papanicolou techniques. Resected specimen shall be submitted for histopathological examination for correlative study.

Inclusion criteria: Breast lumps diagnosed as breast neoplasms by fine

needle aspiration cytology are included in the study.

Exclusion criteria: Non-neoplastic breast lesions diagnosed on fine needle aspiration

cytology are excluded from the study.

7.3  Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

a.  Special stains if required shall be done.

b.  Any other investigations if required will be undertaken.

7.4  Has ethical clearance been obtained from your institution in case of 7.3?

–YES –

7.5 Duration of study: 18 months

8. LIST OF REFERENCES:

1.  Veneti S, Ioannidoe-Mouzaka L, Toufexi H, Xnenitides J, Anastasiadis P : Imprint cytology. A rapid, reliable method of diagnosing breast malignancy. Acta Cytol. 1996 Jul – Aug ; 40 (4) : 649 – 52.

2.  Issam M. Francis, Dilip K.Das : Role of fine needle aspiration cytology, intraoperative imprint cytology and frozen section in the diagnosis of breast lumps.

International Journal of Kuwait University. Health scan centre.

Volume 8, No 3, 1999.

3.  Creager, Andrew J, Shaw, Jo Ann, Young… et al: Intraoperative evaluation of lumpectomy margins by imprint cytology with histology correlation : A community hospital experience.

Archieves of Pathology and Laboratory Medicine, Jul 2002.

4.  Hemalatha AL, Vidyakumari M, Rupashree S : Intraoperative imprint cytodiagnosis of breast lesions – A Current Perspective.

Journal of Cytology 2005 ; 22 (1) : 23- 27.

5.  Hiregowdar Abhijit D, Godhi Ashok S, Malur Prakash R, Gogeri Basavaraj V, Metgud Shrishail C : Accuracy of intraoperative imprint smears in breast tumours : A study of 40 cases with review of literature.

Indian J Surg (serial online) 2006. (cited 2007 Aug 4) ; 68: 302 – 305.

6.  Maria Fotou, Vassiliki Oikonomou, Flora Zagouri, Theodoros N Sergentanis, Afroditi Nonni… et al: Imprint cytology on microcalcifications excised by preliminary diagnosis.

World Journal of Surgical Oncology 2007, Volume 5:40.

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