Evaluation of lymph nodes in squamous cell carcinoma of the cervix: touch imprint cytology versus frozen section histology

Metastatic involvement of pelvic lymph nodes (LNs) is the most important ne gative predictor of survival in early stage cervical cancer. Because the pr esence of nodal metastases precludes the continuance of any radical surgica l procedure, an extraperitoneal LN dissection is performed and LNs are sent for frozen section (FS). As the time for routine FS is about 15 minutes pe r LN, the use of a faster method, cytology by touch imprint (TI), was inves tigated. A prospective study was performed to determine the feasibility of TI techni que vs. FS. Three hundred eighteen pelvic and para-aortic LNs from 32 patients with cer vical cancer of stage I-IV were bisected and submitted for FS after TI had been prepared. Twenty-nine nodes (9.1%) revealed metastatic squamous cell c arcinoma (SCC) by frozen section histology. Twenty-six of these were diagno sed by TI and confirmed histologically. Reasons for the 3 false negatives i ncluded inadequate preparation or misinterpretation of the TI. Permanent hi stology always agreed with the frozen section result. Cytologic evaluation of pelvic LNs for SCC at the time of intraoperative consultation had a sens itivity and specificity of 90% and 100%, respectively. Touch imprints may provide a sensitive, specific, and time-efficient method to diagnose nodal metastases in cervical SCC.