Intraoperative Prediction of the Two Axillary Lymph Node Macrometastases Threshold in Patients with Breast Cancer Using a One-step Nucleic Acid Cytokeratin-19 Amplification Assay

Overview

Journal Mol Clin Oncol

Specialty Oncology

Date 2017 Nov 17

PMID 29142748

Citations 7

Authors

Victoria Fung

Stan Kohlhardt

Patricia Vergani

Gregory J Zardin

Norman R Williams

Affiliations

Soon will be listed here.

Abstract

The aim of the present study was to assess the sensitivity, specificity and practicality of using a one-step nucleic acid amplification (OSNA) assay during breast cancer staging surgery to predict and discriminate between at least 2 involved nodes and more than 2 involved nodes and facilitate the decision to provide axillary conservation in the presence of a low total axillary node tumour burden. A total of 700 consecutive patients, not treated with neo-adjuvant chemotherapy, received intraoperative sentinel lymph node (SLN) analysis using OSNA for cT1-T3 cN0 invasive breast cancer. Patients with at least one macrometastasis on whole-node SLN analysis underwent axillary lymph node dissection (ALND). The total tumour load (TTL) of the macrometastatic SLN sample was compared with the non-sentinel lymph node (NSLN) status of the ALND specimen using routine histological assessment. In total, 122/683 patients (17.9%) were found to have an OSNA TTL indicative of macrometastasis. In addition, 45/122 (37%) patients had NSLN metastases on ALND with a total positive lymph node burden exceeding the American College of Surgeons Oncology Group Z0011 trial threshold of two macrometastatic nodes. The TTL negative predictive value was 0.975 [95% confidence interval (CI), 0.962-0.988]. The area under the curve for the receiver operating characteristic curve was 0.86 (95% CI, 0.81-0.91), indicating that SLN TTL was associated with the prediction (and partitioning) of total axillary disease burden. OSNA identifies a TTL threshold value where, in the presence of involved SLNs, ALND may be avoided. This technique offers objective confidence in adopting conservative management of the axilla in patients with SLN macrometastases.

Citing Articles

Impact of analysis of the sentinel lymph node by one-step nucleic acid amplification (OSNA) compared to conventional histopathology on axillary and systemic treatment: data from the Dutch nationwide cohort of breast cancer patients.

van Haaren E, Poodt I, Spiekerman van Weezelenburg M, van Bastelaar J, Janssen A, de Vries B Breast Cancer Res Treat. 2023; 202(2):245-255.

PMID: 37495799 PMC: 10505596. DOI: 10.1007/s10549-023-07065-0.

Intraoperative Molecular Analysis of Total Tumor Load in Sentinel Lymph Node: A Predictor of Axillary Status in Early Breast Cancer.

Laohawiriyakamol S, Mahattanobon S, Puttawibul P Asian Pac J Cancer Prev. 2022; 23(1):349-354.

PMID: 35092404 PMC: 9258672. DOI: 10.31557/APJCP.2022.23.1.349.

Can one-step nucleic acid amplification assay predict four or more positive axillary lymph node involvement in breast cancer patients: a single-centre retrospective study.

Kenny R, Wong G, Gould L, Odofin O, Bowyer R, Sotheran W Ann R Coll Surg Engl. 2021; 104(3):216-220.

PMID: 34928727 PMC: 10334894. DOI: 10.1308/rcsann.2021.0154.

Application of OSNA Nomogram in Patients With Macrometastatic Sentinel Lymph Node: A Retrospective Assessment of Accuracy.

Combi F, Andreotti A, Gambini A, Palma E, Papi S, Biroli A Breast Cancer (Auckl). 2021; 15:11782234211014796.

PMID: 33994790 PMC: 8113365. DOI: 10.1177/11782234211014796.

Sentinel lymph node biopsy with one-step nucleic acid assay relegates the need for preoperative ultrasound-guided biopsy staging of the axilla in patients with early stage breast cancer.

Inua B, Fung V, Al-Shurbasi N, Howells S, Hatsiopoulou O, Somarajan P Mol Clin Oncol. 2021; 14(3):51.

PMID: 33604041 PMC: 7849070. DOI: 10.3892/mco.2021.2213.

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