Clinical Research Papers:

Clinical significance of MSKCC nomogram on guiding the application of touch imprint cytology and frozen section in intraoperative assessment of breast sentinel lymph nodes

Lisha Sun, Guanglei Chen, Yizhen Zhou, Lei Zhang, Zining Jin, Weiguang Liu, Guangping Wu, Feng Jin, Kai Li and Bo Chen _

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Oncotarget. 2017; 8:78105-78112. https://doi.org/10.18632/oncotarget.17490

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Lisha Sun1,2,*, Guanglei Chen3,*, Yizhen Zhou1, Lei Zhang1, Zining Jin1, Weiguang Liu1, Guangping Wu4, Feng Jin1, Kai Li2 and Bo Chen1

1 Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China

2 Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, China

3 Department of Breast Disease and Reconstruction Center, Breast Cancer Key Laboratory of Dalian, The Second Hospital of Dalian Medical University, Dalian, China

4 Department of Pathology, The First Hospital of China Medical University, Shenyang, China

* Co-first authors

Correspondence to:

Bo Chen, email:

Kai Li, email:

Keywords: early breast cancer, intraoperative detection, Memorial Sloan Kettering Cancer Center nomogram, touch imprint cytology, frozen section

Received: November 18, 2016 Accepted: April 07, 2017 Published: April 27, 2017


The widely practiced intra-operative methods for rapid evaluation and detection of sentinel lymph node (SLN) status include frozen section (FS) and touch imprint cytology (TIC). This study optimized the use of TIC and FS in the intra-operative detection of breast SLNs based on the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram. Three hundred forty-two SLNs were removed from 79 patients. SLN metastatic probability was assessed by the MSKCC nomogram. The SLNs underwent intra-operative TIC and FS, as well as routine post-operative paraffin sections (RPSs). The relationships between TIC, FS, and SLN metastatic probability were analyzed. Overall, TIC was more sensitive than FS (92.31% vs. 76.92%), while TIC specificity was inferior to FS specificity (84.85% vs. 100%). In addition, the best cut-off value for TIC based on the MSKCC nomogram was inferior to the best FS cut-off value (22.5% vs. 34.5%). All patients with a MSKCC value <22.5% in the present study were negative based on FS and RPS, while the true-negative and false-positive rates for TIC were 92.5% and 7.5%, respectively. Thus, early breast cancer patients, based on a MSKCC value <22.5%, can safely avoid FS, but should have TIC performed intra-operatively. Patients with a MSKCC value >22.5% should have TIC and FS to determine the size of metastases, whether or not to proceed with axillary lymph node dissection, and to avoid easily missed metastases.

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