Molecular subtype-driven disparities in intraoperative touch imprint cytology accuracy for sentinel lymph node assessment in clinically node-positive breast cancer treated with neoadjuvant chemotherapy - Research Findings

Q: What question does the study address about ITPC?

It evaluates how molecular subtype affects the accuracy of intraoperative touch imprint cytology for sentinel lymph node assessment in cN+ breast cancer patients treated with neoadjuvant chemotherapy.

Q: How was diagnostic performance measured?

Sensitivity, specificity, NPV, and the false-negative rate were calculated by comparing ITPC results with final histopathological diagnosis, then stratified by molecular subtype.

Q: Which molecular subtypes showed different ITPC performance?

HER2-positive (nonluminal) tumors had the highest tpCR and a low false-negative rate, Luminal B (HER2-positive) had moderate tpCR with a higher false-negative rate, while Luminal A and Luminal B (HER2-negative) showed lower tpCR with higher false-negative rates; TNBC showed a higher tpCR with the lowest false-negative rate.

Q: What factors were independently linked to false-negative ITPC results?

Chemotherapy-induced changes in SLNs and residual micrometastases/ITCs were independent influencing factors for false-negative results.

Sep 30, 2026

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Study investigates how breast cancer molecular subtype influences the diagnostic accuracy of intraoperative touch imprint cytology (ITPC) for sentinel lymph node (SLN) assessment in clinically axillary node-positive (cN+) patients receiving neoadjuvant chemotherapy (NAC). A retrospective cohort of 232 patients undergoing NAC followed by SLN biopsy with ITPC quantified sensitivity, specificity, NPV, and false-negative rate against final histopathology and stratified results by subtype. Results show substantial subtype-dependent performance and identify chemotherapy-induced SLN changes and residual micrometastases/ITCs as independent predictors of false negatives.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

Molecular subtypes in breast cancer

Sentinel lymph node biopsy and prognostic value

Intraoperative evaluation methods and role of ITPC

Wan etal. European Journal European Journal of Medical Research (2026) 31:32 [https://doi.org/10.1186/s40001-025-03569-1](https://doi.org/10.1186/s40001-025-03569-1 of Medical Research)[ of Medical Research](https://doi.org/10.1186/s40001-025-03569-1 of Medical Research) RESEARCH Open Access Molecular subtype-driven disparities in intraoperative touch imprint cytology accuracy for sentinel lymph node assessment in clinically node-positive breast cancer treated with neoadjuvant chemotherapy Xiaochun Wan1,2,3†, Bing Chen2,5,6†, Hao Zhang1,2,3, Ying Chen1,2,3, Fei Ren1,2,3, Di Shi1,2,3, Bo Ping1,2,3, Wentao Yang1,2,3, Ping Wei1,2,3,4* and Yanli Wang1,2,3* Abstract Background This study aimed to investigate the impact of molecular subtype on the accuracy of intraoperative touch imprint cytology (ITPC) for sentinel lymph node (SLN) evaluation in clinically axillary node-positive (cN +) breast cancer patients treated with neoadjuvant chemotherapy (NAC) . Methods We conducted a retrospective cohort study of 232 cN + breast cancer patients undergoing NAC followed by SLN biopsy with ITPC. Diagnostic performance values (sensitivity, specificity, NPV, false-negative rate, etc.) were calculated against final histopathological diagnosis, and stratified by molecular subtypes. Results ITPC identified 53 positive cases (23 false-negatives) across 917 SLNs, demonstrating 69. 74% sensitivity, 100% specificity, and 87 . 15% NPV. HER2-positive (nonluminal) tumors showed the highest tpCR (67 . 53%) with a moderate SLN-positive rate (24 . 14%) and the lowest false-negative rate (3 . 90%) . Luminal B (HER2-positive) tumors exhibited a moderate tpCR (57 . 89%) and a SLN-positive rate (29 . 31%) but a higher false-negative rate (13 . 79%) . In contrast, both Luminal A and Luminal B HER2-negative displayed lower tpCRs (0 . 00% and 20 . 00%), higher SLN-positive rates (66 . 67% and 57. 78%), and higher false-negative rates (33 . 33% and 22. 22%) . Notably, TNBC showed a tpCR of 48 . 98%, a SLN-positive rate of 34 . 69%, and the lowest false-negative rate of 2 . 04% . Chemotherapy-induced changes in SLNs (OR = 11 . 155, 95% CI 2 .002–62. 152; p = 0 . 006) and residual micrometastases/ITCs (OR = 37 . 843, 95% CI 5.031–284. 671; p < 0. 0001) were independent influencing factors of false-negative results. Conclusions Collectively, our study demonstrates that ITPC exhibits a robust accuracy for detecting SLN metastases in cN + breast cancer patients treated with NAC. The findings support the implementation of molecular subtypespecific SLN management: ITPC alone may be adequate for HER2-positive and TNBC tumors; for hormone receptorpositive (Luminal) subtypes, ITPC may need to be combined with molecular/immunohistochemical analysis. †Xiaochun Wan and Bing Chen have contributed equally to this work. *Correspondence: Ping Wei [weiping@fudan.edu.cn](weiping@fudan.edu.cn)[ ](weiping@fudan.edu.cn)Yanli Wang [drwyl@126.com](drwyl@126.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copy

FAQs

What question does the study address about ITPC?

It evaluates how molecular subtype affects the accuracy of intraoperative touch imprint cytology for sentinel lymph node assessment in cN+ breast cancer patients treated with neoadjuvant chemotherapy.

How was diagnostic performance measured?

Sensitivity, specificity, NPV, and the false-negative rate were calculated by comparing ITPC results with final histopathological diagnosis, then stratified by molecular subtype.

Which molecular subtypes showed different ITPC performance?

HER2-positive (nonluminal) tumors had the highest tpCR and a low false-negative rate, Luminal B (HER2-positive) had moderate tpCR with a higher false-negative rate, while Luminal A and Luminal B (HER2-negative) showed lower tpCR with higher false-negative rates; TNBC showed a higher tpCR with the lowest false-negative rate.

What factors were independently linked to false-negative ITPC results?

Chemotherapy-induced changes in SLNs and residual micrometastases/ITCs were independent influencing factors for false-negative results.

Sep 30, 2026

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