Sentinel lymph node (SN) mapping has recently become a standard of care in surgical
treatment of certain malignancies such as breast cancer and malignant melanoma. This
procedure has especially revolutionized the surgical treatment option for breast cancer
patients by avoiding unnecessary complete axillary lymph node dissection (CLND) and
its complications in patients who have negative SNs [
1
,
2
]. Intraoperative evaluation allows the patients who have positive SNs to undergo more
cost-effective CLND during the same surgery [
[3]
]; however, the accuracy of sensitive intraoperative detection of SN metastasis, particularly
micrometastasis, has become a challenge among pathologists. Currently there is no
standardized protocol for intraoperative evaluation. Determining the most appropriate
manner for intraoperative evaluation of SN is the responsibility of the individual
pathologist, and should be determined on a case-by-case basis. Some prefer frozen
section, and others favor cytological evaluation using touch imprint or scrape preparations,
with or without intraoperative, low-molecular–weight cytokeratin immunohistochemical
stain (CK-IHC). Some prefer none, with deferral to permanent sections. The advantages
of intraoperative imprint cytology (IIC) over frozen section include: it preserves
the lymph node architecture, prevents loss of micrometastases, costs less, has faster
turnaround time, and can sample multiple cut surfaces. The major disadvantage of both
IIC and frozen section is that both techniques have rather low sensitivity in grossly
negative SNs. Acknowledging the advantages and disadvantages of both frozen section
and cytologic preparations, there is absolutely no intraoperative method with perfect
sensitivity and specificity. The H. Lee Moffitt Cancer Center (MCC) in Tampa, Florida,
was one of the first centers to introduce and use intraoperative imprint cytology
(IIC) of the SN, and has been doing so since 1997 [
4
,
5
]. In this section, the authors emphasize techniques and results related to IIC of
SN based on an institutional protocol.To read this article in full you will need to make a payment
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