A Systematic Review and Meta-analysis of Touch Imprint Cytology and Frozen Section Biopsy and Their Comparison for Evaluation of Sentinel Lymph Node in Breast Cancer

World J Surg. 2023 Feb;47(2):478-488. doi: 10.1007/s00268-022-06800-w. Epub 2022 Oct 30.


Introduction: Evaluation of axillary lymph nodes after sentinel lymph node biopsy (SLNB) in breast cancer is mostly done by intra-operative frozen section biopsy (FSB) and/ or touch imprint cytology (TIC). In this systematic review and meta-analysis, we have compared the accuracy of the two modalities.

Methods: PubMed, EMBASE, and Cochrane electronic databases were searched for articles comparing TIC with FSB. Articles were assessed for methodological and reporting quality. The main summary measures were pooled sensitivity, pooled specificity, and diagnostic accuracy using bivariate generalized linear mixed models using random effects.

Results: Fourteen studies were included. The pooled sensitivity, specificity, and diagnostic accuracy for FSB were 78%, 100%, and 98.57%. For TIC, the pooled sensitivity, specificity, and diagnostic accuracy were 74%, 98%, and 98.37%. For both methods, visual inspection of summary ROC curves and of forest plots did not show significant heterogeneity.

Conclusion: TIC showed comparable sensitivity, specificity, and accuracy to FSB and hence can be used as its substitute as a rapid and economical test for the detection of axillary lymph node metastasis during SLNB especially in low-resource settings.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Breast Neoplasms* / pathology
  • Female
  • Frozen Sections
  • Humans
  • Lymph Nodes / pathology
  • Lymphadenopathy* / pathology
  • Sensitivity and Specificity
  • Sentinel Lymph Node Biopsy / methods
  • Sentinel Lymph Node* / pathology