Application of rapid direct immunohistochemistry for intraoperative diagnosis of breast lesions and sentinel node biopsies
LIU Mei
LI Xi-ru
SONG Xin
ZANG Jin-feng
QIU Xiao-mei
ZHENG Yi-qiong
SHI Huai-yin
Abstract：Objective To improve intraoperative diagnostic accuracy of breast lesions and sentinel node biopsy and to validate applications of rapid direct immunohistochemistry (RD-IHC) for frozen sections of breast tissues and lymph nodes.Methods RD-IHC staining using horse radish peroxidase (HRP) polymer labeled CK5,smooth muscle myosin heavy chain (SM-MHC),cytokeratin and CK8/18 antibodies were performed on frozen sections of breast lesions and sentinel nodes.The diagnostic results based on frozen sections with combinations of RD-IHC on frozen tissues were compared with the diagnostic results of formalin fixed tissues (FFPE) sections and conventional IHC on FFPE tissues.Results There were 1162 cases in the study.Intraoperative diagnoses were as follows:398 cases of invasive breast carcinomas,44 ductal carcinomas in situ (DCIS),7 malignant breast tumors unclassified,21 phyllodes tumors,432 fibroadenomas,162 benign adenosis,3 gynecomastia,59 inflammatory lesions,and 36 deferred diagnoses.There were 388 sentinel node biopsies used for intraoperative frozen section diagnoses of cancer metastases.In the intraoperative RD-IHC group,diagnostic accuracy of all breast lesions improved from 95.6％ to 98.3％ (P ＜ 0.01) and the diagnostic accuracy for sentinel node biopsies improved from 96.9 ％ to 99.2％ (P ＜ 0.01).Furthermore,uses of intraoperative RD-IHC also significantly reduced deferred diagnoses for both breast lesions (from 3.1％ to 1.7％,P ＜0.01) and sentinel node biopsies (from 2.1％ to 0,P ＜ 0.01).Conclusions Applications of RD-IHC for frozen section breast lesions and sentinel node biopsies demonstrate improved intraoperative diagnostic accuracy and reduced rates of deferred diagnoses for both breast lesions and sentinel node biopsies.The RD-IHC protocol is simple and efficient.The total procedures can be finished within 10 min that allows its use for intraoperative frozen section diagnosis without expensive devices.
Keywords：Invasive breast cancerDuctal carcinoma in situ (DCIS)Frozen section diagnosisDirect immunohistochemistry
Publication Date：2018-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 170-176 )