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Bernet-Vegué L, Cantero-González C, Sancho de Salas M, Parada D, Perin T, Quintero-Niño Z, Vieites Pérez-Quintela B, Sánchez-Guzmán D, Castelvetere M, Hardisson Hernaez D, Martín-Salvago MD. Validation of prognostic and predictive value of total tumoral load after primary systemic therapy in breast cancer using OSNA assay. Clin Transl Oncol 2024; 26:1220-1228. [PMID: 38070048 PMCID: PMC11026238 DOI: 10.1007/s12094-023-03347-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/03/2023] [Indexed: 04/20/2024]
Abstract
PURPOSE This study aimed to validate the classification of breast cancer (BC) patients in progression risk groups based on total tumor load (TTL) value to predict lymph node (LN) affectation after neo-adjuvant systemic therapy (NAST) obtained in the NEOVATTL study. METHODS/PATIENTS This was an observational, retrospective, international, multicenter study including patients with infiltrating BC who received NAST followed by sentinel lymph node biopsy (SLNB) analyzed with one-step nucleic acid amplification (OSNA) from nine Spanish and two Italian hospitals. Patients were classified into three groups according to the progression risk, measured as disease-free survival (DFS), based on TTL values (> 250, 250-25,000, and > 25,000 copies/μL). The previous (NEOVATTL study) Cox regression model for prognosis was validated using prognostic index (PI) and Log ratio test (LRT) analyses; the value of TTL for axillary non-SLN affectation was assessed using receiver operating characteristic (ROC) curves. RESULTS We included 263 patients with a mean age of 51.4 (± SD 10.5) years. Patients with TTL > 25,000 copies/μL had a shorter DFS (HR 3.561 [95% CI 1.693-7.489], p = 0.0008 vs. TTL ≤ 25,000). PI and LRT analyses showed no differences between the two cohorts (p = 0.2553 and p = 0.226, respectively). ROC analysis showed concordance between TTL and non-SLN involvement (area under the curve 0.828), with 95.7% sensitivity and 92.9% specificity at a TTL cut-off of > 15,000 copies/μL. CONCLUSIONS In BC patients who had received NAST and underwent SLNB analysis using OSNA, a TTL value of > 25,000 copies/μL was associated with a higher progression risk and > 15,000 copies/μL was predictive of non-SLN involvement.
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Affiliation(s)
- Laia Bernet-Vegué
- Breast Area, Department of Anatomic Pathology, Ribera Salud Hospitals, Valencia, Spain.
| | | | - Magdalena Sancho de Salas
- Departamento de Anatomía Patológica del, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - David Parada
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Tiziana Perin
- Pathology Unit, Centro di Riferimento Oncologico di Aviano (C.R.O.), IRCCS, Aviano, Italy
| | - Zulma Quintero-Niño
- Departamento de Anatomía Patológica, Hospital Universitario La Ribera, Alzira, Spain
| | | | | | - Marina Castelvetere
- Pathological Anatomy Laboratory, Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
| | - David Hardisson Hernaez
- Department of Pathology, Hospital Universitario La Paz, Molecular Pathology and Therapeutic Targets Group, Hospital La Paz Insitute of Research (IdiPAZ), Center for Biomedical Research in the Cancer Network (CIBERONC), Instituto de Salud Carlos III, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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Park SA, Masunaga N, Kagara N, Ohi Y, Gondo N, Abe K, Yoshinami T, Sota Y, Miyake T, Tanei T, Shimoda M, Sagara Y, Shimazu K. Evaluation of RASSF1A methylation in the lysate of sentinel lymph nodes for detecting breast cancer metastasis: A diagnostic accuracy study. Oncol Lett 2023; 26:475. [PMID: 37809046 PMCID: PMC10551867 DOI: 10.3892/ol.2023.14063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/15/2023] [Indexed: 10/10/2023] Open
Abstract
The restriction enzyme-based digital methylation-specific polymerase chain reaction (RE-dMSP) assay is useful for diagnosing sentinel lymph node (SN) metastasis in patients with breast cancer, by detecting tumor-derived methylated Ras association domain-containing protein 1 (RASSF1A). In addition, this assay has high concordance (95.0%) with one-step nucleic acid amplification (OSNA). The present study aimed to perform RE-dMSP using OSNA lysate from more patients and to re-evaluate its clinical usage. Overall, 418 SNs from 347 patients were evaluated using both OSNA and RE-dMSP. The concordance rate was 83.3% (348/418). RASSF1A methylation of the primary tumors was negative in 36 patients. When these patients were excluded, the concordance rate improved to 88.2% (330/374). Of the 79 OSNA-negative cases, 19 were RE-dMSP-positive, although all were positive for cytokeratin 19 expression in the primary tumor, suggesting that RE-dMSP can detect tumor-derived DNA with a higher sensitivity. The percent of methylated reference of the breast tumors showed a wide variety in the 16 OSNA-positive/RE-dMSP-negative cases, and such variability of methylation could have affected the results in these patients. In conclusion, although RE-dMSP can diagnose SN metastasis with high sensitivity and accuracy, and can be a supplementary tool to OSNA in breast cancer, RE-dMSP showed certain discordance with OSNA and critically depended on the absence or heterogeneity of DNA methylation in breast tumors. Further research is expected to develop an assay targeting other DNA alterations, such as mutations.
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Affiliation(s)
- Sung Ae Park
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Nanae Masunaga
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Naofumi Kagara
- Department of Breast Surgery, Osaka General Medical Center, Osaka 558-8558, Japan
| | - Yasuyo Ohi
- Department of Breast Surgery, Hakuaikai Sagara Hospital, Kagoshima 892-0833, Japan
| | - Naomi Gondo
- Department of Breast Surgery, Hakuaikai Sagara Hospital, Kagoshima 892-0833, Japan
| | - Kaori Abe
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Tetsuhiro Yoshinami
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Yoshiaki Sota
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Tomohiro Miyake
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Tomonori Tanei
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Masafumi Shimoda
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Yasuaki Sagara
- Department of Breast Surgery, Hakuaikai Sagara Hospital, Kagoshima 892-0833, Japan
| | - Kenzo Shimazu
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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Martín-Salvago MD, Sancho M, López-García MÁ, Cano Jiménez A, Pérez-Luque A, Alfaro L, Vieites B. Value of total tumor load as a clinical and pathological factor in the prognosis of breast cancer patients receiving neoadjuvant treatment. Comparison of three populations with three different surgical approaches: NEOVATTL Pro 3 Study. Breast Cancer Res Treat 2023:10.1007/s10549-023-06954-8. [PMID: 37219637 DOI: 10.1007/s10549-023-06954-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/23/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE This study aimed to compare the prognosis in terms of disease-free survival (DFS) in three populations of women with breast cancer (BC) treated with neoadjuvant systemic treatment (NAST) in which axillary lymph node dissection (ALND) was performed based on different total tumor load (TTL) thresholds in the sentinel nodes. METHODS This was an observational, retrospective study carried out in three Spanish centers. Data from patients with infiltrating BC who underwent BC surgery after NAST and intraoperative sentinel lymph node biopsy (SLNB) performed by One Step Nucleic acid Amplification (OSNA) technique during 2017 and 2018 were analyzed. ALND was performed according to the protocol of each center, based on three different TTL cut-offs (TTL > 250, TTL > 5000, and TTL > 15,000 CK19-mRNA copies/μL for centers 1, 2, and 3, respectively). RESULTS A total of 157 BC patients were included in the study. No significant differences in DFS were observed between centers (Hazard ratio [HR] center 2 vs 1: 0.77; p = 0.707; HR center 3 vs 1: 0.83; p = 0.799). Patients with ALND had a shorter DFS (HR 2.43; p = 0.136), albeit not statistically significant. Patients with a triple negative subtype had a worse prognosis than those with other molecular subtypes (HR 2.82; p = 0.056). CONCLUSION No significant differences in DFS were observed between three centers with different surgical approaches to ALND based on different TTL cut-offs in patients with BC after NAST. These results suggest that restricting ALND to those patients with TTL ≥ 15,000 copies/μL is a reliable approximation, avoiding unnecessary morbidities caused by ALND.
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Affiliation(s)
| | - Magdalena Sancho
- Department of Pathology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | | | - Ana Pérez-Luque
- Department of Pathology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Lina Alfaro
- Department of Gynaecology and Obstetrics, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Begoña Vieites
- Department of Pathology, Hospital Universitario Virgen del Rocío, Seville, Spain.
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García Chiloeches A, González Barranquero A, Juéz Sáez LD, Corral Moreno S, Rivas Fidalgo S, Pastor Peinado P, Cabañas Montero LJ, Fernández Cebrián JM. Intraoperative sentinel node biopsy, is it worth the wait? Cir Esp 2023; 101:325-332. [PMID: 36152966 DOI: 10.1016/j.cireng.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/01/2022] [Indexed: 05/16/2023]
Abstract
INTRODUCTION In our institution, the study of selective sentinel node biopsy (SLNB) is performed intraoperatively. The main objective of our study is to know the proportion of patients who benefits from the waiting of the results of SLNB. METHODS A retrospective analysis of patients operated on our center between January 1st, 2018 and June 30, 2019 was carried out. We included women diagnosed with T1-T2 tumors, treated by lumpectomy and SLNB studied using OSNA method. RESULTS Our study included 149 women. There were not statistically significant differences in terms of demographic data between the group treated with axillary lymph node dissection (ALND) and exclusively SLNB group. After analysis of SLN intraoperatively, there were performed 18 axillary lymphadenectomies. Only in six of this 18 cases, three or more sentinel nodes were founded. The location of the tumor, the presence of lymphovascular permeation and the total tumor load (TTL) showed statistically significant differences between groups. Only the TTL was established as the independent factor of the need for ALND. DISCUSSION Obtaining a deferred result of the SLNB allowed reducing the time of anesthesia and occupation of the operating room, since in a high percentage of cases an additional procedure is not performed.
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Affiliation(s)
- Alba García Chiloeches
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | | | - Luz Divina Juéz Sáez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Sara Corral Moreno
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Sonia Rivas Fidalgo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Paula Pastor Peinado
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Rodrigo-Calvo MT, Saez de Gordoa K, Lopez-Prades S, Archilla I, Diaz A, Berrios M, Camps J, Musulen E, Cuatrecasas M. Tumour Cell Seeding to Lymph Nodes from In Situ Colorectal Cancer. Cancers (Basel) 2023; 15:cancers15030842. [PMID: 36765800 PMCID: PMC9913321 DOI: 10.3390/cancers15030842] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023] Open
Abstract
Lymph node (LN) metastasis is an important prognostic factor in colorectal cancer (CRC). We aimed to demonstrate the presence of lymphatic vessels (LV) in the mucosa of in-situ (pTis) CRC, and of detectable tumour burden in regional LNs. This is an observational retrospective study of 39 surgically resected in situ CRCs. The number of LVs was evaluated in both pTis and normal mucosa using D2-40 immunostains. All LNs were assessed with both H&E and the One Step Nucleic Acid Amplification (OSNA) assay, and the results were correlated with clinicopathological features. D2-40 immunohistochemisty revealed LVs in the lamina propria of all pTis CRC (100%), being absent in normal mucosa. A median of 16 LNs were freshly dissected per patient, and all cases were pN0 with H&E. Molecular LN analysis with OSNA revealed the presence of low amounts of tumour burden in 11/39 (28%) cases (range 400 to 4270 CK19 mRNA copies/µL), which had no clinical consequences. This study demonstrates the presence of LVs in the lamina propria in 100% of pTis CRC, as well as the presence of low amounts of tumour burden in regional LNs, only detected by molecular methods. Given the prognostic value of LN tumour burden, its molecular quantification may help a patient's clinical management.
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Affiliation(s)
- Maria Teresa Rodrigo-Calvo
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain
- Molecular Pathology of Inflammatory Conditions and Solid Tumours Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Karmele Saez de Gordoa
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain
- Molecular Pathology of Inflammatory Conditions and Solid Tumours Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Sandra Lopez-Prades
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain
- Molecular Pathology of Inflammatory Conditions and Solid Tumours Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Ivan Archilla
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain
- Molecular Pathology of Inflammatory Conditions and Solid Tumours Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Alba Diaz
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain
- Molecular Pathology of Inflammatory Conditions and Solid Tumours Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Department of Basic Clinical Practice, University of Barcelona (UB), 08036 Barcelona, Spain
| | - Mario Berrios
- Pathology Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Jordi Camps
- Molecular Pathology of Inflammatory Conditions and Solid Tumours Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Gastroenterology Department, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain
- Department of Cell Biology, Physiology and Immunology, Faculty of Medicine, University Autonomous of Barcelona, 08193 Bellaterra, Spain
| | - Eva Musulen
- Pathology Department, Hospital Universitari General de Catalunya-Grupo QuironSalud, Sant Cugat del Vallès, 08195 Barcelona, Spain
- Josep Carreras Leukaemia Research Institute, Badalona, 08916 Barcelona, Spain
- Correspondence: (E.M.); (M.C.); Tel.: +34-935047940 (E.M.); +34-932275536 (M.C.)
| | - Miriam Cuatrecasas
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain
- Molecular Pathology of Inflammatory Conditions and Solid Tumours Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Department of Basic Clinical Practice, University of Barcelona (UB), 08036 Barcelona, Spain
- Correspondence: (E.M.); (M.C.); Tel.: +34-935047940 (E.M.); +34-932275536 (M.C.)
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Bernet L, Hardisson D, Rodrigo M, Córdoba A, Sancho M, Peg V, Ruiz I, Godey F, Sánchez-Méndez JI, Prat A. OSNA Total Tumor Load for the Prediction of Axillary Involvement in Breast Cancer Patients: Should We use Different Thresholds According to the Intrinsic Molecular Subtype? MOTTO Study. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2023; 16:2632010X231183693. [PMID: 37534372 PMCID: PMC10392164 DOI: 10.1177/2632010x231183693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/05/2023] [Indexed: 08/04/2023]
Abstract
Aims To assess the impact of the molecular subtype (MS) on the total number of CK19 mRNA copies in all positive SLN (TTL) threshold, to predict non-SLN affectation, and to compare 5 years progression-free survival (PFS) according to the risk of recurrence (ROR) group by PAM50. Methods Cohort with infiltrating breast cancer with intra-operative metastatic SLN detected by one-step nucleic acid amplification (OSNA) assay who underwent subsequent ALND. Logistic regression was used to assess a possible interaction between TTL and MS(Triple Negative, Her-2-Enriched, Luminal A, or Luminal B), or hormone receptors (HR: positive or negative) by immunohistochemistry (IMH). Cox regression was used to compare PFS and OS in the 3 ROR groups (high, medium, or low). Results TTL was predictive of non-SLN affectation in both univariate (OR [95% CI]: 1.72 [1.43, 2.05], P < .001) and multivariate (1.55 [95% CI: 1.04, 2.32], P = .030) models, but MS-IMH or HR-IMH, and their interactions with TTL were not (best multivariate model: HR + main effect OR 1.16 [95% CI: 0.18, 7.64], P = .874; interaction OR: 1.04 [0.7, 1.55], P = .835; univariate model: HR + main effect OR: 1.44 [95% CI: 0.85, 2.44], P = .180). PFS was lower in the high-risk ROR group (81.1%) than in the low-risk group (93.9%) (HR: 3.68 [95 CI: 1.70, 7.94], P < .001). Conclusions our results do not provide evidence to support the utilization of subtype-specific thresholds for TTL values to make therapeutic decisions on the axilla. The ROR group was predictive of 5 years-PFS.
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Affiliation(s)
- L Bernet
- Department of Pathology, Hospital Universitario del Vinalopó, Elche, Spain
| | - D Hardisson
- Department of Pathology, Hospital Universitario La Paz, Madrid
- Hospital La Paz Institute for health Research (IdiPAZ), Universidad Autónoma de Madrid
| | - M Rodrigo
- Department of Pathology, Hospital Universitario de Burgos, Burgos, Spain
| | - A Córdoba
- Department of Pathology, Hospital Universitario de Navarra, Navarra, Spain
| | - M Sancho
- Department of Pathology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - V Peg
- Department of Pathology, Vall d’Hebron University Hospital, Barcelona, Spain
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Spanish Biomedical Research Network Centre in Oncology (CIBERONC), Madrid, Spain
| | - I Ruiz
- Department of Pathology, Hospital Universitario de Donostia, Donostia, Spain
| | - F Godey
- Department of Pathology, Centre Eugène Marquis, Rennes, France
| | - JI Sánchez-Méndez
- Department of Ginecology and Obstetrics, Hospital Universitario La Paz, Madrid
- Hospital La Paz Institute for Health Research (IdiPAZ), Universidad Autónoma de Madrid
| | - A Prat
- Medical Oncology department, Hospital Clínic de Barcelona, Barcelona, Spain
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Cytology Smears: An Enhanced Alternative Method for Colorectal Cancer pN Stage-A Multicentre Study. Cancers (Basel) 2022; 14:cancers14246072. [PMID: 36551559 PMCID: PMC9775901 DOI: 10.3390/cancers14246072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Stage II colorectal cancer (CRC) recurrence remains a clinical problem. Some of these patients are true stage III CRC with a pN0 pathology stage. This large prospective multicentre cohort study aimed at evaluating the diagnostic ability of lymph node (LN) cytology smears to perform the pN stage and compare it with the conventional haematoxylin and eosin (H&E) pathology pN stage. Additionally, we used the One-Step Nucleic Acid Amplification (OSNA), a high-sensitive molecular method of LN staging. A total of 3936 fresh LNs from 217 CRC surgical specimens were examined by three methods, H&E, LN cytology smears, and OSNA. H&E detected 29% of patients with positive LNs, cytology smears 35%, and OSNA 33.2% (p < 0.0001). H&E and cytology concordantly classified 92.2% of tumours, and 88.5% between OSNA and H&E. Cytology had 96.8% sensitivity and 90.3% specificity to discriminate positive/negative patients compared to H&E (p = 0.004), and 87.3% sensitivity and 89% specificity when compared to OSNA (p = 0.56). Patients with positive LNs detected by any of the three methods had significantly worse disease-free and overall survival. We conclude that pN stage accuracy for detecting positive LNs is superior with LN cytological smears than with conventional H&E, which would enable a better pN stage and management of early-stage CRC patients.
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Kim R, Kawai A, Wakisaka M, Shimoyama M, Yasuda N, Ito M, Kin T, Arihiro K. Outcomes in patients with non‐invasive breast carcinoma. Cancer Rep (Hoboken) 2022; 6:e1768. [PMID: 36494178 PMCID: PMC10075290 DOI: 10.1002/cnr2.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIM Non-invasive breast carcinoma is considered to be localized disease and is distinguished from invasive ductal and lobular carcinomas. The local recurrence of non-invasive carcinoma after surgery may lead to development of invasive carcinoma and promote distant metastasis, which worsens the prognosis for breast cancer mortality. The distant metastasis of non-invasive carcinoma may involve the ductal microvasculature without invasion. The outcomes of non-invasive breast carcinoma were examined in this retrospective cohort study. METHODS AND RESULTS Of 872 primary breast cancers diagnosed at a single center between May 2008 and March 2022, 93 (10.6%) were found to be non-invasive carcinomas and were examined in this study. The breast cancer recurrence and survival rates of patients with non-invasive carcinoma were analyzed retrospectively. The median follow-up period was 1891 (range, 5-4804) days. All patients underwent surgical treatment [mastectomy with sentinel lymph node biopsy (SLNB) and partial mastectomy with or without SLNB, tumorectomy, and microdochectomy]. Postoperatively, radiation therapy was administered to 73 (78.4%) of the patients and endocrine therapy was administered to 64 (81.0%) of 79 patients with hormone-receptor positivity. Of 26 patients who underwent partial mastectomy with SLNB, 24 (92.3%) showed isolated tumor cells in the SLNs on one-step nucleic acid amplification. Local recurrence was observed in three (0.3%) patients; no distant metastasis was observed. One patient died of a noncancerous disease. The overall survival rate was 98.0% and the breast cancer-specific survival rate was 100.0%. CONCLUSIONS Non-invasive breast carcinoma, like invasive breast carcinoma, causes local recurrence, but has a good prognosis without distant metastasis. The clinical significance of isolated tumor cells in the SLNs as a systemic component of non-invasive breast carcinoma remains to be elucidated.
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Affiliation(s)
- Ryungsa Kim
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Ami Kawai
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Megumi Wakisaka
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Mika Shimoyama
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Naomi Yasuda
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Mitsuya Ito
- Department of Breast Surgery Hiroshima City Hospital Hiroshima Japan
| | - Takanori Kin
- Department of Breast Surgery Hiroshima City Hospital Hiroshima Japan
| | - Koji Arihiro
- Department of Anatomical Pathology Hiroshima University Hospital Hiroshima Japan
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Gante I, Ribeiro JM, Mendes J, Gomes A, Almeida V, Regateiro FS, Caramelo F, Silva HC, Figueiredo-Dias M. One Step Nucleic Acid Amplification (OSNA) Lysate Samples Are Suitable to Establish a Transcriptional Metastatic Signature in Patients with Early Stage Hormone Receptors-Positive Breast Cancer. Cancers (Basel) 2022; 14:5855. [PMID: 36497336 PMCID: PMC9736102 DOI: 10.3390/cancers14235855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
The One Step Nucleic Acid Amplification (OSNA) is being adopted worldwide for sentinel lymph nodes (SLNs) staging in breast cancer (BC). As major disadvantage, OSNA precludes prognostic information based on structural evaluation of SLNs. Our aim is to identify biomarkers related to tumor-microenvironment interplay exploring gene expression data from the OSNA remaining lysate. This study included 32 patients with early stage hormone receptors-positive BC. Remaining OSNA lysates were prepared for targeted RNA-sequencing analysis. Identification of differentially expressed genes (DEGs) was performed by DESeq2 in R and data analysis in STATA. The results show that, in metastatic SLNs, several genes were upregulated: KRT7, VTCN1, CD44, GATA3, ALOX15B, RORC, NECTIN2, LRG1, CD276, FOXM1 and IGF1R. Hierarchical clustering analysis revealed three different clusters. The identified DEGs codify proteins mainly involved in cancer aggressiveness and with impact in immune response. The overexpression of the immune suppressive genes VTCN1 and CD276 may explain that no direct evidence of activation of immune response in metastatic SLNs was found. We show that OSNA results may be improved incorporating microenvironment-related biomarkers that may be useful in the future for prognosis stratification and immunotherapy selection. As OSNA assay is being implemented for SLNs staging in other cancers, this approach could also have a wider utility.
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Affiliation(s)
- Inês Gante
- Gynecology Department, Coimbra Hospital and Universitary Centre (CHUC), 3004-561 Coimbra, Portugal
- University of Coimbra, Gynecology University Clinic, Faculty of Medicine, 3000-548 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Joana Martins Ribeiro
- Laboratory of Sequencing and Functional Genomics of UCGenomics, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - João Mendes
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Laboratory of Sequencing and Functional Genomics of UCGenomics, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Ana Gomes
- Department of Pathology, Coimbra Hospital and Universitary Centre (CHUC), 3004-561 Coimbra, Portugal
| | - Vânia Almeida
- Department of Pathology, Coimbra Hospital and Universitary Centre (CHUC), 3004-561 Coimbra, Portugal
- Institute of Anatomical and Molecular Pathology, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Frederico Soares Regateiro
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Allergy and Clinical Immunology Unit, Coimbra Hospital and Universitary Centre (CHUC), 3004-561 Coimbra, Portugal
- Institute of Immunology, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Francisco Caramelo
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Laboratory of Biostatistics and Medical Informatics (LBIM), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Henriqueta Coimbra Silva
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Laboratory of Sequencing and Functional Genomics of UCGenomics, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Margarida Figueiredo-Dias
- Gynecology Department, Coimbra Hospital and Universitary Centre (CHUC), 3004-561 Coimbra, Portugal
- University of Coimbra, Gynecology University Clinic, Faculty of Medicine, 3000-548 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
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Algara M, Rodríguez E, Martínez-Arcelus FJ, Salinas J, Sanz X, Beato I, Manso A, Soler A, Rodríguez JR, Frías A, Calín A, Juan G, Meireles P, Flaquer A. OPTimizing Irradiation through Molecular Assessment of Lymph node (OPTIMAL): a randomized clinical trial. Radiother Oncol 2022; 176:76-82. [PMID: 36210628 DOI: 10.1016/j.radonc.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/06/2022] [Accepted: 09/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE In breast cancer (BC) patients, the involvement of four or more lymph nodes (LN) is an indication of regional irradiation. The optimal treatment strategy remains unclear when fewer nodes are involved and lymphadenectomy is not performed. We designed a clinical trial to show the non-inferiority of Incidental (INC) compared to intentional (INT) irradiation of axillary nodes in patients with early-stage BC and low burden LN involvement. MATERIALS AND METHODS BC patients, cN0 (n = 487) undergoing breast conservation surgery and sentinel node biopsy, with total tumor load assessed by OSNA (One-Step Nucleic Acid Amplification) of 250-15,000 copies mRNA CK19/µL in sentinel LN were randomized to receive INC or INT nodal irradiation. The primary endpoint was 5-year disease-free survival (DFS). Secondary endpoints were locoregional recurrence (LRR), distant recurrence (DR), and acute and chronic toxicity (CT). RESULTS Five-years DFS were 93.7% (INC) and 93.8% (INT) (difference 0.1% [one-sided 95% CI < 5.7%]; non-inferiority p = 0.075). Cumulative Incidences of LRR were 3.5% (INC) and 3.4% (INT) (difference of 0.1% [<4.8%]; p = 0.021), and 5% (INC) and 3.5% (INT) (difference 1.4% [<6.0%]; non-inferiority p = 0.101) for DR. CT was more Incident with INT (26.9%) than with INC (19.2%), though the difference was not statistically significant (HR 1.39 [95% CI: 0.92, 2.10]; p = 0.11). CONCLUSION Intentional does not outperform incidental irradiation by more than 5.7% in terms of 5-year DFS, 4.8% for LRR, and 6% for DR. REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT02335957.
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Affiliation(s)
- Manuel Algara
- Radiation Oncology Department, Del Mar Hospital, Passeig Maritim 25, 08003 Barcelona, Spain.
| | - Elvira Rodríguez
- Radiation Oncology Department, Virgen del Rocío University Hospital, Av. Manuel Siurot, S/n, 41013 Sevilla, Spain.
| | - Francisco José Martínez-Arcelus
- Radiation Oncology Department, La Fe Polytechnic University Hospital, Av. Fernando Abril Martorell, 106, 46026 Valencia, Spain.
| | - Juan Salinas
- Radiation Oncology Department, Santa Lucia General University Hospital, C. Minarete, s/n, 30202 Cartagena, Spain.
| | - Xavier Sanz
- Radiation Oncology Department, Del Mar Hospital, Passeig Maritim 25, 08003 Barcelona, Spain.
| | - Inmaculada Beato
- Radiation Oncology Department, Castellón Provincial Hospital, Av. del Dr. Clarà, 19, 12002 Castellón de La Plana, Spain.
| | - Aurea Manso
- Radiation Oncology Department, La Paz University Hospital, P.° de la Castellana, 261, 28046 Madrid, Spain.
| | - Ana Soler
- Radiation Oncology Department, De La Ribera Hospital, km 1, Ctra. Corbera, 46600 Alzira, Spain.
| | - José Reyes Rodríguez
- Radiation Oncology Department, University Hospital of Leon, C. Altos de Nava, s/n, 24071 León, Spain.
| | - Andere Frías
- Radiation Oncology Department, de Cruces University Hospital, Plaza de Cruces, 48903 Barakaldo, Spain.
| | - Ana Calín
- Radiation Oncology Department, Gregorio Marañón University General Hospital, C. Dr. Esquerdo, 46, 28007 Madrid, Spain.
| | - Germán Juan
- Radiation Oncology Department, Cabueñes University Hospital, Los Prados, 395, 33394 Gijón, Spain.
| | - Pedro Meireles
- Radiation Oncology Department, São João Universitary Hospital Center, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Amanda Flaquer
- Radiation Oncology Department, Araba Txagorritxu University Hospital, Jose Atxotegi Kalea, s/n, 01009 Gasteiz, Spain.
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11
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A New Possible Cut-Off of Cytokeratin 19 mRNA Copy Number by OSNA in the Sentinel Node of Breast Cancer Patients to Avoid Unnecessary Axillary Dissection: A 10-Year Experience in a Tertiary Breast Unit. Cancers (Basel) 2022; 14:cancers14143384. [PMID: 35884447 PMCID: PMC9318019 DOI: 10.3390/cancers14143384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary This manuscript aims to investigate the features of patients with metastatic sentinel lymph node (SLN), evaluated by OSNA, and to predict which patients have a high risk of positive ALND. The finding of the present study suggests a new cut-off of CK19 mRNA copy number in the sentinel lymph node useful to personalize surgical treatments and avoid unnecessary axillary surgical treatments. Abstract (1) Background: The main discriminant in breast cancer prognosis is axillary lymph node status. In a select cohort of patients, axillary lymph node dissection (ALND) may be safely spared. This study aimed to determine a new possible cut-off of cytokeratin (CK) 19 mRNA copy number in the SLN to predict cases at high risk of positive ALND. (2) Methods: Clinical records of 1339 patients were retrospectively reviewed and were separated into two groups according to the axillary status (negative: ALNs− and positive ALNs+). Receiver operative characteristic (ROC) curves were used to identify a new optimal cut-off of CK19 mRNA copy number in SLN; (3) Results: Large tumor size and high grade were found mostly in ALNs+. Results from the ROC analyses, with an AUC of 82.1%, identified a new cut-off (9150 CK19 mRNA copies) showing 94% sensitivity, 67.3% specificity, 61.2% positive, and 95.3% negative predictive values; (4) OSNA remains the most-important intra-operative tool to identify patients who can benefit from ALND but with the traditional cut-off, many patients undergo needless ALND. The results of the present study suggest a new cut-off helpful to personalize surgical treatment and avoid unnecessary invasive procedures.
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12
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Application of One-Step Nucleic Acid Amplification (OSNA) in different cancer entities and usefulness in prostate cancer: a systematic review. BMC Cancer 2022; 22:357. [PMID: 35366849 PMCID: PMC8976947 DOI: 10.1186/s12885-022-09355-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background Lymph node (LN) status is a key prognostic factor in the decision-making process of different cancer entities, including prostate cancer (PCa). Sectioning and haematoxylin and eosin (H&E) staining technique remain the gold standard for the evaluation of LN metastases despite some limitations, especially low sensitivity in detecting an accurate tumour burden within the LN, as well as a subjective and time-consuming result. One-step nucleic acid amplification (OSNA) quantifies mRNA copies of cytokeratin 19 (CK19) in a fast, objective, automated, and reproducible way, raising a general interest to explore its utility for lymphatic metastasis identification in different malignancies. Methods To present the latest evidence related to the detection of LN metastases in several tumours by using OSNA compared with the conventional H&E method, a systematic review of articles published since March 2021 was conducted using PubMed, Cochrane Library, and Web of Science databases. References from primary papers and review articles were checked to obtain further potential studies. Our procedure for evaluating records identified during the literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. With the aim to design and justify future clinical routine use of OSNA in PCa, novel PCa evidence has been included in this review for the first time. Results Twenty five studies were included. LN from six different groups of tumours: breast, gastrointestinal, gynecological, lung, head and neck and prostate cancers has been assessed. OSNA was compared with post-operative formalin-fixed paraffin-embedded tissue sections with H&E staining as the reference standard. Contingency tables were created, and concordance rate, sensitivity, specificity and predictive values were reported. Seventeen studies analysed the discordant cases using different techniques. Conclusion OSNA method has a high diagnostic accuracy for the detection of LN metastases in several CK19 expressing tumours. Available evidence might encourage future investigations about its usage in PCa patients to improve LN staging and prognosis.
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García Chiloeches A, González Barranquero A, Juéz Sáez LD, Corral Moreno S, Rivas Fidalgo S, Pastor Peinado P, Cabañas Montero LJ, Fernández Cebrián JM. Biopsia selectiva de ganglio centinela en cáncer de mama, ¿está justificada la espera al resultado intraoperatorio? Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Detection of lymph node metastasis in non-small cell lung cancer using the new system of one-step nucleic acid amplification assay. PLoS One 2022; 17:e0265603. [PMID: 35312731 PMCID: PMC8936453 DOI: 10.1371/journal.pone.0265603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 03/06/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction The prognosis of non-small cell lung cancer greatly depends on the presence of lymph node metastasis, which limits the need for surgery and adjuvant therapy for advanced cancer. One-step nucleic acid amplification of cytokeratin19 (CK19) mRNA was used to detect lymph node metastasis. Automated Gene Amplification Detector RD-200 and the LYNOAMP CK19 gene amplification reagent as components of the new one-step nucleic acid amplification system, which has increased gene amplification efficiency by improving the reagent composition, have shorter preprocessing and measurement times than conventional systems. We aimed to compare the clinical performance of the new system with that of histopathology and the conventional system. Materials and methods 199 lymph nodes from 58 non-small cell lung cancer patients who underwent lymph node dissection were examined intraoperatively using the new system, conventional system, and histopathology. Results Lymph node metastasis was diagnosed in 32, 42, and 44 patients using histopathological analysis, the new system, and the conventional system, respectively. Compared with histopathological analysis, the concordance rate, sensitivity, specificity, positive predictive value, and negative predictive value of the new system were 92.0%, 90.6%, 92.2%, 69.0%, and 98.1%, respectively, and compared with the conventional system, the values were 95.0%, 86.4%, 97.4%, 90.5%, and 96.2%, respectively. Conclusion The clinical performance of the new one-step nucleic acid amplification system in detecting lymph node metastasis of lung cancer is comparable to that of histopathology and the conventional system; its performance was sufficient for determining the appropriate clinical treatment. The new rapid system can be effectively utilized during lung cancer treatment intraoperatively and postoperatively.
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15
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Osako T, Matsuura M, Yotsumoto D, Takayama S, Kaneko K, Takahashi M, Shimazu K, Yoshidome K, Kuraoka K, Itakura M, Tani M, Ishikawa T, Ohi Y, Kinoshita T, Sato N, Tsujimoto M, Nakamura S, Tsuda H, Noguchi S, Akiyama F. A prediction model for early systemic recurrence in breast cancer using a molecular diagnostic analysis of sentinel lymph nodes: A large-scale, multicenter cohort study. Cancer 2022; 128:1913-1920. [PMID: 35226357 PMCID: PMC9311203 DOI: 10.1002/cncr.34144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The one-step nucleic acid amplification (OSNA) assay can quantify the cytokeratin 19 messenger RNA copy number as a proxy for sentinel lymph node (SN) metastasis in breast cancer. A large-scale, multicenter cohort study was performed to determine the prognostic value of the SN tumor burden based on a molecular readout and to establish a model for the prediction of early systemic recurrence in patients using the OSNA assay. METHODS SN biopsies from 4757 patients with breast cancer were analyzed with the OSNA assay. The patients were randomly assigned to the training or validation cohort at a ratio of 2:1. On the basis of the training cohort, the threshold SN tumor burden value for stratifying distant recurrence was determined with Youden's index; predictors of distant recurrence were investigated via multivariable analyses. Based on the selected predictors, a model for estimating 5-year distant recurrence-free survival was constructed, and predictive performance was measured with the validation cohort. RESULTS The prognostic cutoff value for the SN tumor burden was 1100 copies/μL. The following variables were significantly associated with distant recurrence and were used to construct the prediction model: SN tumor burden, age, pT classification, grade, progesterone receptor, adjuvant cytotoxic chemotherapy, and adjuvant anti-human epidermal growth factor receptor 2 therapy. The values for the area under the curve, sensitivity, specificity, and accuracy of the prediction model were 0.83, 63.4%, 81.7%, and 81.1%, respectively. CONCLUSIONS Using the OSNA assay, the molecular readout-based SN tumor burden is an independent prognostic factor for early breast cancer. This model accurately predicts early systemic recurrence and may facilitate decision-making related to treatment.
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Affiliation(s)
- Tomo Osako
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masaaki Matsuura
- Division of Cancer Genomics, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Daisuke Yotsumoto
- Department of Breast Surgery, Hakuaikai Sagara Hospital, Kagoshima, Japan
| | - Shin Takayama
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Kaneko
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Mina Takahashi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Kenzo Shimazu
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Kazuya Kuraoka
- Department of Diagnostic Pathology, National Hospital Organization Kure Medical Center/Chugoku Cancer Center, Hiroshima, Japan
| | - Masayuki Itakura
- Division of Breast and Endocrine Surgery, Shimane University Hospital, Shimane, Japan
| | - Mayumi Tani
- Department of Breast and Endocrine Surgery, Nihon University Hospital, Tokyo, Japan
| | - Takashi Ishikawa
- Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasuyo Ohi
- Department of Pathology, Hakuaikai Sagara Hospital, Kagoshima, Japan
| | - Takayuki Kinoshita
- Department of Breast Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Nobuaki Sato
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | | | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College, Saitama, Japan
| | - Shinzaburo Noguchi
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Futoshi Akiyama
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
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16
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Merino San Martín E, Frías Aldeguer L, Ordás Álvarez P, García Calvo L, Escabias del Pozo C, Domínguez Gadea L, Martí Álvarez C, Hernández Gutiérrez A, Sánchez-Méndez J. Indications and results of sentinel lymph node biopsy in breast cancer: Changes observed in 2018 compared to 2012. Rev Esp Med Nucl Imagen Mol 2022; 41:345-349. [DOI: 10.1016/j.remnie.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/15/2021] [Indexed: 10/19/2022]
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17
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Pina H, Salleron J, Gilson P, Husson M, Rouyer M, Leroux A, Rauch P, Marchal F, Käppeli M, Merlin JL, Harlé A. Intraoperative prediction of non‑sentinel lymph node metastases in breast cancer using cytokeratin 19 mRNA copy number: A retrospective analysis. Mol Clin Oncol 2022; 16:58. [DOI: 10.3892/mco.2022.2491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/10/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- Heloïse Pina
- Département de Biopathologie, Institut de Cancérologie de Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France
| | - Julia Salleron
- Département de Biostatistique, Institut de Cancérologie de Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France
| | | | - Marie Husson
- Département de Biopathologie, Institut de Cancérologie de Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France
| | - Marie Rouyer
- Département de Biopathologie, Institut de Cancérologie de Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France
| | - Agnes Leroux
- Département de Biopathologie, Institut de Cancérologie de Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France
| | - Philippe Rauch
- Département de Chirurgie, Institut de Cancérologie de Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France
| | | | | | - Jean-Louis Merlin
- Département de Biopathologie, Institut de Cancérologie de Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France
| | - Alexandre Harlé
- Département de Biopathologie, Institut de Cancérologie de Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France
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18
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Merino San Martín E, Frías Aldeguer L, Ordás Álvarez P, García Calvo L, Escabias del Pozo C, Domínguez Gadea L, Martí Álvarez C, Hernández Gutiérrez A, Sánchez-Méndez J. Indicaciones y resultados de la biopsia del ganglio centinela en el cáncer de mama: cambios observados en el año 2018 respecto al año 2012. Rev Esp Med Nucl Imagen Mol 2021. [DOI: 10.1016/j.remn.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Escuin D, López-Vilaró L, Mora J, Bell O, Moral A, Pérez I, Arqueros C, García-Valdecasas B, Ramón Y Cajal T, Lerma E, Barnadas A. Circulating microRNAs in Early Breast Cancer Patients and Its Association With Lymph Node Metastases. Front Oncol 2021; 11:627811. [PMID: 34513655 PMCID: PMC8428362 DOI: 10.3389/fonc.2021.627811] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 08/04/2021] [Indexed: 12/13/2022] Open
Abstract
MicroRNAs have emerged as important regulators of the metastatic process. In addition, circulating miRNAs appear to be surprisingly stable in peripheral blood making them ideal noninvasive biomarkers for disease diagnosis. Here, we performed a proof-of-principle study to investigate the expression profile of circulating miRNAs and their association with the metastatic lymph node status in early breast cancer patients. Sentinel lymph node status was detected by one-step nucleic acid (OSNA) analysis. We performed RNA-sequencing in 16 plasma samples and validated the results by qPCR. Gene Ontology term enrichment and KEGG pathway analyses were carried out using DAVID tools. We found16 differentially expressed miRNAs (q < 0.01) in patients with positive SLNs. Fourteen miRNAs were down-regulated (miR-339-5p, miR-133a-3p, miR-326, miR-331-3p, miR-369-3p, miR-328-3p, miR-26a-3p, miR-139-3p, miR-493-3p, miR-664a-5p, miR-146a-5p, miR-323b-3p, miR-1307-3p and miR-423-3p) and 2 were up-regulated (miR-101-3pand miR-144-3p). Hierarchical clustering using differentially expressed miRNAs clearly distinguished patients according to their lymph node status. Gene ontology analysis showed a significant enrichment of biological processes associated with the regulation of the epithelial mesenchymal transition, cell proliferation and transcriptional regulation. Our results suggest the potential role of several circulating miRNAs as surrogate markers of lymph node metastases in early breast cancer patients. Further validation in a larger cohort of patients will be necessary to confirm our results.
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Affiliation(s)
- Daniel Escuin
- Clinical Oncology Research Group, Institut d'Investigacions Biomédiques Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Laura López-Vilaró
- Clinical Oncology Research Group, Institut d'Investigacions Biomédiques Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Josefina Mora
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Olga Bell
- Clinical Oncology Research Group, Institut d'Investigacions Biomédiques Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Antonio Moral
- Department of General Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,School of Medicine, Universitat Autónoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
| | - Ignacio Pérez
- Department of General Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina Arqueros
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Teresa Ramón Y Cajal
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Enrique Lerma
- Clinical Oncology Research Group, Institut d'Investigacions Biomédiques Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,School of Medicine, Universitat Autónoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
| | - Agustí Barnadas
- Clinical Oncology Research Group, Institut d'Investigacions Biomédiques Sant Pau (IIB-Sant Pau), Barcelona, Spain.,School of Medicine, Universitat Autónoma de Barcelona (UAB), Cerdanyola del Vallès, Spain.,Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
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Sentinel lymph node biopsy in breast cancer after neoadjuvant therapy using a magnetic tracer versus standard technique: A multicentre comparative non-inferiority study (IMAGINE-II). INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ultrastaging Using Ex Vivo Sentinel Lymph Node Mapping and One-Step Nucleic Acid Amplification (OSNA) in Gastric Cancer: Experiences of a European Center. Cancers (Basel) 2021; 13:cancers13112683. [PMID: 34072392 PMCID: PMC8198451 DOI: 10.3390/cancers13112683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/11/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary In this study, the effectiveness of One-step nucleic acid amplification (OSNA) in combination with ex vivo SLN mapping is compared with conventional histology including immunohistochemistry. OSNA lymph node evaluation has been performed in 41 gastric cancer cases. It showed a high effectiveness with sensitivity, specificity, and accuracy rates of 85.4%, 93.5%, and 92.4%, respectively The LN status could be predicted in 40 cases and led to upstaging in three cases (14%). The OSNA method proved its potential to increase the sensitivity of metastases detection. Abstract Background: In this study, the effectiveness of One-step nucleic acid amplification (OSNA) in combination with ex vivo SLN mapping is compared with conventional histology including immunohistochemistry. Methods: LNs were retrieved from gastrectomy specimens in an unfixed state. After ex vivo SLN mapping using methylene-blue, LNs were sliced to provide samples for histology and OSNA. Results: In total, 334 LNs were retrieved in the fresh state from 41 patients. SLN detection was intended in 40 cases but was successful in only 29, with a correct LN status prediction in 23 cases (79%). Excluding one case out of 41 with a failure likely caused by a processing error, OSNA showed a high effectiveness with sensitivity, specificity, and accuracy rates of 85.4%, 93.5%, and 92.4%, respectively. The LN status could be predicted in all but one case, in which the single positive LN was not eligible for OSNA testing. Moreover, OSNA evaluation led to upstaging from N0 to N+ in three cases (14%). Conclusion: The ex vivo SLN protocol used resulted in a relatively poor detection rate. However, the OSNA method was not hampered by this detection rate and proved its potential to increase the sensitivity of metastases detection.
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Combi F, Andreotti A, Gambini A, Palma E, Papi S, Biroli A, Zaccarelli S, Ficarra G, Tazzioli G. Application of OSNA Nomogram in Patients With Macrometastatic Sentinel Lymph Node: A Retrospective Assessment of Accuracy. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2021; 15:11782234211014796. [PMID: 33994790 PMCID: PMC8113365 DOI: 10.1177/11782234211014796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/14/2021] [Indexed: 11/24/2022]
Abstract
Introduction: Almost 50% to 70% of patients who undergo axillary lymph node dissection (ALND) because of a single metastatic sentinel lymph node (SLN) have no further metastatic nodes at the axillary histology. On these grounds, the one-step nucleic acid amplification (OSNA) nomogram was designed and validated. As a mathematical model, calculated through tumor size (expressed in millimeters) and CK19 mRNA copy number, it is thought to predict nonsentinel lymph node (NSLN) status. The aim of the study is to verify the diagnostic accuracy of the OSNA nomogram in a group of patients with macrometastatic SLN, with a retrospective analysis. Methods: The OSNA nomogram was retrospectively applied to a group of 66 patients with macrometastatic SLN who underwent ALND. The result of the final histology of the axillary cavity was compared to the nomogram prediction. We calculated the prevalence of NSLN metastasis in patients who underwent ALND, sensitivity and specificity, negative and positive predictive value of the nomogram. Results: In patients with macrometastasis in SLN, the prevalence of patients with metastatic NSLN was 45%. The sensitivity of the nomogram was excellent (90%). The specificity was low (36%). Positive predictive value amounted to 54%, while negative predictive value was good (81%). Conclusions: These results suggest that the OSNA nomogram is a valid instrument that can help choose the best surgical strategy for the treatment of axillary cavity. The mathematical model is useful to avoid surgery in a selected group of patients because it accurately predicts NSLN status.
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Affiliation(s)
- Francesca Combi
- Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
- Francesca Combi, Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Via Università 4, 41121 Modena (MO), Italy. Emails: ;
| | - Alessia Andreotti
- Division of Breast Surgical Oncology, Department of Medical and Surgical Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy
| | - Anna Gambini
- Division of Breast Surgical Oncology, Department of Medical and Surgical Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy
| | - Enza Palma
- Division of Breast Surgical Oncology, Department of Medical and Surgical Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy
| | - Simona Papi
- Division of Breast Surgical Oncology, Department of Medical and Surgical Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy
| | - Alice Biroli
- Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Guido Ficarra
- Department of Pathology, University Hospital of Modena, Modena, Italy
| | - Giovanni Tazzioli
- Division of Breast Surgical Oncology, Department of Medical and Surgical Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy
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Predictive and prognostic value of total tumor load in sentinel lymph nodes in breast cancer patients after neoadjuvant treatment using one-step nucleic acid amplification: the NEOVATTL study. Clin Transl Oncol 2021; 23:1377-1385. [PMID: 33517542 PMCID: PMC8192368 DOI: 10.1007/s12094-020-02530-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
Objective To evaluate the predictive and prognostic value of total tumor load (TTL) in sentinel lymph nodes (SLNs) in patients with infiltrating breast cancer after neoadjuvant systemic therapy (NST). Methods This retrospective multicenter study used data from a Spanish Sentinel Lymph Node database. Patients underwent intraoperative SLN biopsy after NST. TTL was determined from whole nodes using a one-step nucleic acid amplification (OSNA) assay and defined as the total sum of CK19 mRNA copies in all positive SLNs. Cox-regression models identified independent predictive variables, which were incorporated into a nomogram to predict axillary non-SLN metastasis, and identified prognostic variables for incorporation into a disease-free survival (DFS) prognostic score. Results A total of 314 patients were included; most had no lymph node involvement prior to NST (cN0; 75.0% of patients). Most received chemotherapy with or without biologic therapy (91.7%), and 81 patients had a pathologic complete response. TTL was predictive of non-SLN involvement (area under the concentration curve = 0.87), and at a cut-off of 15,000 copies/µL had a negative predictive value of 90.5%. Nomogram parameters included log (TTL + 1), maximum tumor diameter and study-defined NST response. TTL was prognostic of disease recurrence and DFS at a cut-off of 25,000 copies/µL. After a 5-year follow-up, DFS was higher in patients with ≤ 25,000 copies/µL than those with > 25,000 (89.9% vs. 70.0%; p = 0.0017). Conclusions TTL > 15,000 mRNA copies/µL was predictive of non-SLN involvement and TTL > 25,000 mRNA copies/µL was associated with a higher risk of disease recurrence in breast cancer patients who had received NST. Supplementary Information The online version contains supplementary material available at 10.1007/s12094-020-02530-4.
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24
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Sharma RD, Sharmin A, Sinha A, Solomon A, Huynh I, Alani A, Nagarajakumar A, Kasem A, Doddi S. Is it Possible to Predict Non Sentinel Node Positivity on the Basis of mRNA Copy Numbers of CK19 Receptor in Breast Cancer? Clin Breast Cancer 2021; 21:e561-e564. [PMID: 33712365 DOI: 10.1016/j.clbc.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/25/2020] [Accepted: 01/18/2021] [Indexed: 11/18/2022]
Abstract
AIMS To determine if there is any correlation between the number of positive non-sentinel lymph nodes (NSLN) and the mRNA copy numbers of cytokeratin 19 receptor on one step nucleic acid amplification (OSNA) in the sentinel lymph node (SLN). METHODS An 8-year retrospective study of consecutive patients who had primary surgery and sentinel node biopsy for breast cancer from January 2011 to December 2018 was carried out. All these patients had intra-operative analysis of sentinel lymph nodes by OSNA. Patients who had neoadjuvant chemotherapy or neoadjuvant endocrine therapy were excluded. RESULTS There were 1159 patients with an age range of 24 to 90 years and a mean age of 63 years in this study. A total of 1324 SLNs were analyzed by OSNA. Macrometastasis was found in 120 patients and they underwent axillary lymph node dissection (ALND). A total of 2405 NSLNs were analyzed. Of the patients who had ALND, 51 (43%) patients had negative NSLNs and 69 (57%) had positive NSLNs. The mean mRNA copy numbers respectively for the 2 groups were 853,665 and 609,855. The difference between the means is not statistically significant (P = 0.82). Also the Receiver Operating Characteristic (ROC) Curve of the total CK-19 mRNA copy number for both groups-negative and positive NSLN were almost identical (Figure 3) indicating mRNA copy numbers cannot be used to discriminate between positive and negative non-sentinel lymph nodes. CONCLUSION It is clear from our study that in patients who have ALND due to macromets on OSNA, there is no correlation between the total tumor load as represented by mRNA copy numbers and the likelihood of positive non-sentinel lymph nodes. We therefore cannot rely solely on the mRNA copy numbers to decide on ALND.
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Affiliation(s)
- Rishabha Deva Sharma
- Department of General and Breast Surgery, Royal United Hospitals Bath NHS, Foundation Trust, Bath, UK
| | - Afroza Sharmin
- Department of Breast Surgery, Kings College NHS Foundation Trust, Princess Royal, University Hospital, Orpington, BR6 8ND, UK
| | - Aaditya Sinha
- Department of General Surgery, Worcester Royal Hospital, Worcester, UK
| | - Ashley Solomon
- Department of Breast Surgery, Kings College NHS Foundation Trust, Princess Royal, University Hospital, Orpington, BR6 8ND, UK
| | - Isabelle Huynh
- Department of Breast Surgery, Kings College NHS Foundation Trust, Princess Royal, University Hospital, Orpington, BR6 8ND, UK.
| | - Azhar Alani
- Department of Breast Surgery, Kings College NHS Foundation Trust, Princess Royal, University Hospital, Orpington, BR6 8ND, UK
| | - Anupama Nagarajakumar
- Department of Breast Surgery, Kings College NHS Foundation Trust, Princess Royal, University Hospital, Orpington, BR6 8ND, UK
| | - Abdul Kasem
- Department of Breast Surgery, Kings College NHS Foundation Trust, Princess Royal, University Hospital, Orpington, BR6 8ND, UK
| | - Sudeendra Doddi
- Department of Breast Surgery, Kings College NHS Foundation Trust, Princess Royal, University Hospital, Orpington, BR6 8ND, UK.
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25
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Inua B, Fung V, Al-Shurbasi N, Howells S, Hatsiopoulou O, Somarajan P, Zardin GJ, Williams NR, Kohlhardt S. 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. Mol Clin Oncol 2021; 14:51. [PMID: 33604041 PMCID: PMC7849070 DOI: 10.3892/mco.2021.2213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 08/21/2020] [Indexed: 11/26/2022] Open
Abstract
Avoiding axillary node clearance in patients with early stage breast cancer and low-burden node-positive axillary disease is an emerging practice. Informing the decision to adopt axillary conservation is examined by comparing routine preoperative axillary staging using ultrasound (AUS) ± AUS biopsy (AUSB) with intraoperative staging using sentinel lymph node biopsy (SLNB) and a one-step nucleic acid cytokeratin-19 amplification assay (OSNA). A single-centre, retrospective cohort study of 1,315 consecutive new diagnoses of breast cancer in 1,306 patients was undertaken in the present study. An AUS ± AUSB was performed on all patients as part of their initial assessment. Patients who had a normal ultrasound (AUS-) or negative biopsy (AUSB-) followed by SLNB with OSNA ± axillary lymph node dissection (ALND), and those with a positive AUSB (AUSB+), were assessed. Tests for association were determined using a χ2 and Fisher's Exact test. A total of 266 (20.4%) patients with cT1-3 cN0 staging received 271 AUSBs. Of these, 205 biopsies were positive and 66 were negative. The 684 patients with an AUS-/AUSB-assessment proceeded to SLNB with OSNA. AUS sensitivity and negative predictive value (NPV) were 0.53 [0.44-0.62; 95% confidence interval (CI)] and 0.58 (0.53-0.64, 95% CI), respectively. Using a total tumour load cut-off of 15,000 copies/µl to predict ≥2 macro-metastases, the sensitivity and NPV for OSNA were 0.82 (0.71-0.92, 95% CI) and 0.98 (0.97-0.99, 95% CI) (OSNA vs. AUS P<0.0001). Of the AUSB+ patients, 51% had ≤2 positive nodes following ALND and were potentially over-treated. Where available, SLNB with OSNA should replace AUSB for axillary assessment in cT1-2 cN0 patients with ≤2 indeterminate nodes seen on AUS.
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Affiliation(s)
- Bello Inua
- Department of Breast, Plastic and Reconstructive Surgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Victoria Fung
- Department of Breast, Plastic and Reconstructive Surgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Nour Al-Shurbasi
- Department of Breast, Plastic and Reconstructive Surgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Sarah Howells
- Department of Breast Screening and Breast Imaging, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Olga Hatsiopoulou
- Department of Breast Screening and Breast Imaging, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Praveen Somarajan
- Department of Breast Screening and Breast Imaging, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Gregory J Zardin
- Department of Histopathology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London W1W 7JN, UK
| | - Stan Kohlhardt
- Department of Breast, Plastic and Reconstructive Surgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
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26
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Peña KB, Kepa A, Cochs A, Riu F, Parada D, Gumà J. Total Tumor Load of mRNA Cytokeratin 19 in the Sentinel Lymph Node as a Predictive Value of Axillary Lymphadenectomy in Patients with Neoadjuvant Breast Cancer. Genes (Basel) 2021; 12:genes12010077. [PMID: 33435629 PMCID: PMC7826715 DOI: 10.3390/genes12010077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 02/07/2023] Open
Abstract
Although sentinel lymph node biopsy (SLNB) has proved to be able to diagnose axillary lymph node status safely and reliably, there is still not enough evidence to suggest that it can be used in patients who have undergone neoadjuvant chemotherapy (NAC) for lymph node-sparing surgery. The present study used molecular approaches to determine whether SLNB can be reliably used in patients who have been treated with NAC before SLN surgery, and whether the total tumor load of the SLN can be used as a predictive factor in axillary lymphadenectomy (ALD). We used one-step nucleic acid amplification (OSNA) to analyze a total of 111 consecutive patients who presented operable invasive breast carcinomas and who had been treated with NAC. SLN was positive in 55 patients and the identification rate was 100%. In 9 of these 55 patients, ALD showed that other lymph nodes were also involved. In all of the other 46 patients, the only lymph node to be identified as positive was SLN. Metastasis was not found in any of the axillary lymph nodes in the isolated tumor cell group. The total tumor load, defined as the amount of cytokeratin 19 mRNA copy numbers in all positives SLN (copies/µL), showed three risk groups related to the possibility of positive non-sentinel nodes. OSNA is a diagnostic technique that is highly sensitive, specific, and reproducible and it can be used to analyze sentinel lymph nodes after NAC. Total tumor load may be able to help predict additional metastases in axillary lymphadenectomy.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Axilla
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Breast/pathology
- Breast/surgery
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/therapy
- Female
- Humans
- Keratin-19/analysis
- Keratin-19/genetics
- Lymph Node Excision/statistics & numerical data
- Lymphatic Metastasis/diagnosis
- Lymphatic Metastasis/pathology
- Lymphatic Metastasis/therapy
- Mastectomy
- Middle Aged
- Neoadjuvant Therapy
- Predictive Value of Tests
- Prospective Studies
- RNA, Messenger/analysis
- Sentinel Lymph Node/pathology
- Sentinel Lymph Node/surgery
- Sentinel Lymph Node Biopsy
- Tumor Burden/genetics
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Affiliation(s)
- Karla B. Peña
- Department of Pathology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain; (K.B.P.); (F.R.)
| | - Amillano Kepa
- Department of Oncology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain; (A.K.); (A.C.)
| | - Alba Cochs
- Department of Oncology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain; (A.K.); (A.C.)
| | - Francesc Riu
- Department of Pathology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain; (K.B.P.); (F.R.)
| | - David Parada
- Department of Pathology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain; (K.B.P.); (F.R.)
- Correspondence: (D.P.); (J.G.)
| | - Josep Gumà
- Department of Oncology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain; (A.K.); (A.C.)
- Correspondence: (D.P.); (J.G.)
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27
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Escuin D, López-Vilaró L, Bell O, Mora J, Moral A, Pérez JI, Arqueros C, Ramón Y Cajal T, Lerma E, Barnadas A. MicroRNA-1291 Is Associated With Locoregional Metastases in Patients With Early-Stage Breast Cancer. Front Genet 2020; 11:562114. [PMID: 33343622 PMCID: PMC7738477 DOI: 10.3389/fgene.2020.562114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022] Open
Abstract
Evidence that microRNAs (miRNAs) regulate the various steps of metastasis is increasing. Several studies have looked at the miRNA expression profile in primary breast tumors but few have compared primary tumor and sentinel lymph node (SLN) metastasis. We correlated the expression of miRNAs with the SLN status and the outcome of axillary lymph node dissection (ALND) in 60 patients with early breast cancer. We profiled the expression of miRNAs in paired breast tumor samples and SLNs using the NextSeq500 Illumina platform and key findings were validated by qPCR. MultiMiR Bioconductor and Reactome pathways analysis were performed to identify target genes and signaling pathways affected by altered expressed miRNAs. Our results show that nine miRNAs were differentially expressed in tumor tissues (q ≤ 0.05). In tumor samples, a 13.5-fold up-regulation of miR-7641-2 (q < 0.001) and a 2.9-fold down-regulation of miR-1291 (q < 0.001) were associated with tumors with positive SLNs. However, only down-regulation of miR-1291 (q = 0.048) remained significant in paired SLNs samples. Interestingly, a 10.5 up-regulation of miR-1291 in SLNs samples was associated with additional axillary lymph node involvement (q < 0.001). The enrichment analyses showed that canonical and non-canonical WNT pathways and negative regulation of various receptor tyrosine kinases signaling pathways were targets of miR-1291 and supports the role of miR-1291 as a tumor suppressor gene (TSG). Further studies are warranted to investigate the use of miR-1291 as a surrogate biomarker of SLN node metastasis in patients with early-stage breast cancer.
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Affiliation(s)
- Daniel Escuin
- Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Laura López-Vilaró
- Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Olga Bell
- Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Josefina Mora
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Moral
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | | | | | | | - Enrique Lerma
- Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Agustí Barnadas
- Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
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28
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Algara López M, Rodríguez García E, Beato Tortajada I, Martínez Arcelus FJ, Salinas Ramos J, Rodríguez garrido JR, Sanz Latiesas X, Soler Rodríguez A, Juan Rijo G, Flaquer García A. OPTimizing Irradiation through Molecular Assessment of Lymph node (OPTIMAL): a randomized open label trial. Radiat Oncol 2020; 15:229. [PMID: 33008422 PMCID: PMC7531133 DOI: 10.1186/s13014-020-01672-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conservative surgery followed by breast and nodal irradiation is the standard loco-regional early breast cancer (BC) treatment for patients with four or more involved lymph nodes. However, the treatment strategy when fewer nodes are involved remains unclear, especially when lymphadenectomy has not been performed. Sensitive nodal status assessment molecular techniques as the One-Step Nucleic Acid Amplification (OSNA) assay can contribute to the definition and standardization of the treatment strategy. Therefore, the OPTIMAL study aims to demonstrate the feasibility of incidental irradiation of axillary nodes in patients with early-stage BC and limited involvement of the SLN. METHODS BC patients who underwent conservative surgery and whose SLN total tumour load assessed with OSNA ranged between 250-15,000 copies/µL will be eligible. Patients will be randomized to receive irradiation on the breast, tumour bed, axillary and supraclavicular lymph node areas (intentional arm) or only on the breast and tumour bed (incidental arm). All areas, including the internal mammary chain, will be contoured. The mean, median, D5% and D95% doses received in all volumes will be calculated. The primary endpoint is the non-inferiority of the incidental irradiation of axillary nodes compared to the intentional irradiation in terms of 5-year disease free survival. Secondary endpoints comprise the comparison of acute and chronic toxicity and loco-regional and distant disease recurrence rates. DISCUSSION Standardizing the treatment and diagnosis of BC patients with few nodes affected is crucial due to the lack of consensus. Hence, the quantitative score for the metastatic burden of SLN provided by OSNA can contribute by improving the discrimination of which BC patients with limited nodal involvement can benefit from incidental radiation as an adjuvant treatment strategy. TRIAL REGISTRATION ClinicalTrial.gov, NCT02335957; https://clinicaltrials.gov/ct2/show/NCT02335957.
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Affiliation(s)
- Manuel Algara López
- Radiation Oncology Department, Del Mar Hospital, Autonomous University of Barcelona, Hospital del Mar Medical Research Institute, Passeig Maritim, 25, 08003 Barcelona, Spain
| | | | | | | | - Juan Salinas Ramos
- Radiation Oncology Department, Santa Lucia General University Hospital, Cartagena, Spain
| | | | - Xavier Sanz Latiesas
- Radiation Oncology Department, Del Mar Hospital, Pompeu Fabra University, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Germán Juan Rijo
- Radiation Oncology Department, Cabueñes University Hospital, Gijón, Spain
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29
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Sansano I, Vieites B, Sancho de Salas M, García C, Amendoeira I, Bernet L, Pérez-García JM, Espinosa-Bravo M, Rubio IT, Ramón Y Cajal S, Peg V. Axillary staging based on molecular analysis: Results of the B-CLOSER-II study. Pathol Res Pract 2020; 216:153197. [PMID: 32919301 DOI: 10.1016/j.prp.2020.153197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Axillary staging (pN) is a strong predictor of outcome in early stage breast cancer yet following the publication of the Z0011 trial there has been an increasing tendency to spare lymph node dissection. Automated molecular detection of cytokeratin 19mRNA by one-step nucleic acid amplification (OSNA) has been demonstrated to be an accurate method to assess sentinel lymph node (SLN) metastasis. In this study we compare histological and molecular methods following complete axillary lymph node dissection (cALND), determine whether molecular axillary staging affects survival, and evaluate the predictive and prognostic value of total tumor load in ALND (AD-TTL) and in all positive nodes (G-TTL). MATERIAL AND METHODS Axillary lymph nodes were collected from 102 patients with primary breast cancer with histological confirmation of axillary involvement (cN+) or positive SLN. The central 1-mm portion of each non-SLN was processed for hematoxylin-eosin staining and the remaining tissue was analyzed by OSNA. RESULTS Non-SLNs were diagnosed as positive in 72 out of 102 patients (70.6 %) on OSNA compared with only 53 (52 %) on histology (p < 0.01). Thirteen patients would have changed staging if the diagnoses provided had been by molecular methods (p < 0.01), but without a change in prognosis. AD-TTL and G-TTL were predictive of recurrence and mortality. CONCLUSIONS Compared to molecular detection, histological examination significantly underestimates the frequency of axillary node metastases. However, the increase in pN did not show a clinical effect on survival in those patients.
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Affiliation(s)
- Irene Sansano
- Pathology Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129 08035 Barcelona, Spain; Departament de Ciències morfològiques, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129 08035 Barcelona, Spain
| | - Begoña Vieites
- Pathology department, Hospital Universitario Virgen del Rocío, Avda de Manuel Siurot s/n. 41013 Sevilla, Spain
| | - Magdalena Sancho de Salas
- Pathology Department, Hospital Universitario de Salamanca Complejo Asistencial Universitario de Salamanca, Paseo de San Vicente 58-182. 37007 Salamanca, Spain
| | - Carmen García
- Pathology Department, Hospital Universitario de Salamanca Complejo Asistencial Universitario de Salamanca, Paseo de San Vicente 58-182. 37007 Salamanca, Spain
| | - Isabel Amendoeira
- Pathology Department Centro Hospitalar Universitário de S. João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Ipatimup - Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Laia Bernet
- Pathology Department, Hospital Universitario de La Ribera, Ctra. Corbera, km 1, 46600 Alcira, Valencia, Spain
| | | | - Martín Espinosa-Bravo
- Breast Cancer Unit, Hospital Universitari Valld'Hebron. Passeig de la Vall d'Hebron 119-129 08035 Barcelona, Spain
| | - Isabel T Rubio
- Breast Cancer Unit, Clínica Universitaria de Navarra, Calle Marquesado de Sta. Marta, 1, 28027 Madrid, Spain
| | - Santiago Ramón Y Cajal
- Pathology Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129 08035 Barcelona, Spain; Departament de Ciències morfològiques, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129 08035 Barcelona, Spain; Spanish Medical Research Network Centre in Oncology (CIBERONC), Spain
| | - Vicente Peg
- Pathology Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129 08035 Barcelona, Spain; Departament de Ciències morfològiques, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129 08035 Barcelona, Spain; Spanish Medical Research Network Centre in Oncology (CIBERONC), Spain.
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30
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Piñero-Madrona A, Ripoll-Orts F, Sánchez-Méndez JI, Chaves-Benito A, Gómez-de la Bárcena MR, Calatrava-Fons A, Menjón-Beltrán S, Peg-Cámara V. External validation of a prognostic model based on total tumor load of sentinel lymph node for early breast cancer patients. Breast Cancer Res Treat 2020; 181:339-345. [PMID: 32253684 PMCID: PMC7188708 DOI: 10.1007/s10549-020-05623-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/30/2020] [Indexed: 12/23/2022]
Abstract
Background A prognostic model based on the results of molecular analysis of sentinel lymph nodes (SLN) is needed to replace the information that staging the entire axilla provided. The aim of the study is to conduct an external validation of a previously developed model for the prediction of 5-year DFS in a group of breast cancer patients that had undergone SLN biopsy assessed by the One Step Nucleic Acid Amplification (OSNA) method. Methods We collected retrospective data of 889 patients with breast cancer, who had not received systemic treatment before surgery, and who underwent SLN biopsy and evaluation of all SLN by OSNA. The discrimination ability of the model was assessed by the area under the ROC curve (AUC ROC), and its calibration by comparing 5-years DFS Kaplan–Meier estimates in quartile groups of model predicted probabilities (MPP). Results The AUC ROC ranged from 0.78 (at 2 years) to 0.73 (at 5 years) in the training set, and from 0.78 to 0.71, respectively, in the validation set. The MPP allowed to distinguish four groups of patients with heterogeneous DFS (log-rank test p < 0.0001). In the highest risk group, the HR were 6.04 [95% CI 2.70, 13.48] in the training set and 4.79 [2.310, 9.93] in the validation set. Conclusions The model for the prediction of 5-year DFS was successfully validated using the most stringent form of validation, in centers different from those involved in the development of the model. The external validation of the model confirms its utility for the prediction of 5-year DFS and the usefulness of the TTL value as a prognostic variable. Electronic supplementary material The online version of this article (10.1007/s10549-020-05623-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antonio Piñero-Madrona
- Breast Cancer Unit, Department of Surgery, Virgen de La Arrixaca University Hospital, Ctra. Madrid-Cartagena, s/n, El Palmar, 30120, Murcia, Spain.
| | | | | | | | | | | | | | - Vicente Peg-Cámara
- Pathology Department, Vall D'Hebron University Hospital, Barcelona, Spain
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Jimbo K, Kinoshita T, Ogura T, Watase C, Murata T, Shiino S, Takayama S, Yoshida M. Prediction score model for non-sentinel and four or more nodal metastases using a combined method of one-step nucleic acid amplification and histology in sentinel node-positive breast cancer patients. Eur J Surg Oncol 2020; 46:516-521. [DOI: 10.1016/j.ejso.2019.10.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/03/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022] Open
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Sentinel node total tumour load as a predictive factor for non-sentinel node status in early breast cancer patients - The porttle study. Surg Oncol 2019; 32:108-114. [PMID: 31987574 DOI: 10.1016/j.suronc.2019.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/02/2019] [Accepted: 11/25/2019] [Indexed: 11/21/2022]
Abstract
OSNA is a molecular assay for the detection of sentinel node metastasis. TTL emerged as a concept that seems to accurately predict the status of the NSN. Authors tried to confirm this motion. This is a retrospective and multicentric study that analyzed 2164 patients, 579 of whom had positive SN and completion AD. Logistic regression models were performed in order to identify a suitable cutoff to identify patients who benefit from AD. Univariate and multivariate regression analysis showed a relationship between TTL>30000 and the presence of NSN metastasis (OR 2.84, CI 1.99-4.08, p < 0.001). Logistic regression indicated that the cutoff of 30000 copies/μL better discriminates patients with NSN positivity and allows wide use of these criteria. This cutoff value may safely assist clinicians and patients to decide to proceed or not with an AD.
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Major ambulatory surgery in breast diseases. Cir Esp 2019; 98:26-35. [PMID: 31607382 DOI: 10.1016/j.ciresp.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/23/2019] [Accepted: 09/06/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The use of ambulatory surgery (AS) for breast pathology (BP) has increased. The objective of this study is to analyse a group of patients treated surgically for breast pathology in order to evaluate its quality and security in a MAS setting in 2017. METHODS A retrospective review of all patients undergoing breast surgery was conducted within an AS programme from January to December 2017 in Consorcio Hospital General Universitario of Valencia (CHGUV). The study analysed the number of patients, exclusion reasons, type of surgical procedures, evolution of substitution rate (SR), rate and causes of conversion to admission, postoperative complications, motives for not being included in the ambulatory programme and the satisfaction rate of the patients treated with ambulatory surgery. This has been compared with a 2013 group. RESULTS In 2017, 396 procedures for BP were performed: 170 for benign and 226 for malignant disease. The SR for the global mammary pathology was 72.8%. The SR for benign pathology was 93.4% and the SR for malignant pathology was 57.2%, which has increased in recent years from 45.4% in 2013. The unexpected hospitalization rate (HR) of malignant pathologies was 14.1%, while the HR in benign pathologies was 0.6%. Patients hospitalized for malignant pathologies presented higher complications (17%) than ambulatory patients (8.5%) and benign pathologies (6.5%). CONCLUSIONS At the CHGUV, the SR has steadily increased in malignant pathologies. The unexpected hospitalization rate is determined by perioperative sentinel lymph node biopsy results. AS for the treatment of mammary pathology is efficient and safe.
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Diaz-Mercedes S, Archilla I, Camps J, de Lacy A, Gorostiaga I, Momblan D, Ibarzabal A, Maurel J, Chic N, Bombí JA, Balaguer F, Castells A, Aldecoa I, Borras JM, Cuatrecasas M. Budget Impact Analysis of Molecular Lymph Node Staging Versus Conventional Histopathology Staging in Colorectal Carcinoma. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:655-667. [PMID: 31115896 PMCID: PMC6748889 DOI: 10.1007/s40258-019-00482-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND The presence of lymph node (LN) metastasis is a critical prognostic factor in colorectal cancer (CRC) patients and is also an indicator for adjuvant chemotherapy. The gold standard (GS) technique for LN diagnosis and staging is based on the analysis of haematoxylin and eosin (H&E)-stained slides, but its sensitivity is low. As a result, patients may not be properly diagnosed and some may have local recurrence or distant metastases after curative-intent surgery. Many of these diagnostic and treatment problems could be avoided if the one-step nucleic acid amplification assay (OSNA) was used rather than the GS technique. OSNA is a fast, automated, standardised, highly sensitive, quantitative technique for detecting LN metastases. OBJECTIVES The aim of this study was to assess the budget impact of introducing OSNA LN analysis in early-stage CRC patients in the Spanish National Health System (NHS). METHODS A budget impact analysis comparing two scenarios (GS vs. OSNA) was developed within the Spanish NHS framework over a 3-year time frame (2017-2019). The patient population consisted of newly diagnosed CRC patients undergoing surgical treatment, and the following costs were included: initial surgery, pathological diagnosis, staging, follow-up expenses, systemic treatment and surgery after recurrence. One- and two-way sensitivity analyses were performed. RESULTS Using OSNA instead of the GS would have saved €1,509,182, €6,854,501 and €10,814,082 during the first, second and third years of the analysis, respectively, because patients incur additional costs in later years, leading to savings of more than €19 million for the NHS over the 3-year time horizon. CONCLUSIONS Introducing OSNA in CRC LN analysis may represent not only an economic benefit for the NHS but also a clinical benefit for CRC patients since a more accurate staging could be performed, thus avoiding unnecessary treatments.
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Affiliation(s)
- Sherley Diaz-Mercedes
- Pathology Department-Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Ivan Archilla
- Pathology Department-Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Jordi Camps
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
- CIBERehd and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Hospital Clinic, Barcelona, Spain
| | | | - Iñigo Gorostiaga
- Pathology Department, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Dulce Momblan
- Surgical Department, Hospital Clinic, Barcelona, Spain
| | | | - Joan Maurel
- Medical Oncology Department, Hospital Clinic of Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumors Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Nuria Chic
- Medical Oncology Department, Hospital Clinic of Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumors Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Josep Antoni Bombí
- Pathology Department-Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
- CIBERehd and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Hospital Clinic, Barcelona, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
- CIBERehd and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Hospital Clinic, Barcelona, Spain
| | - Iban Aldecoa
- Pathology Department-Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Neurological Tissue Bank of the Biobank Clinic-IDIBAPS-XBTC, Hospital Clinic, Barcelona, Spain
| | - Josep Maria Borras
- Department of Clinical Sciences and Bellvitge Biomedical Research Institute (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department-Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
- Pathology Department, Araba University Hospital, Vitoria-Gasteiz, Spain.
- CIBERehd and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Hospital Clinic, Barcelona, Spain.
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Magnetic detection of sentinel lymph node in papillary thyroid carcinoma: The MAGIC-PAT study results. Eur J Surg Oncol 2019; 45:1175-1181. [DOI: 10.1016/j.ejso.2019.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 01/20/2023] Open
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Sa-Nguanraksa D, O-Charoenrat E, Kulprom A, Samarnthai N, Lohsiriwat V, Nimpoonsri K, O-Charoenrat P. Nomogram to predict non-sentinel lymph node status using total tumor load determined by one-step nucleic acid amplification: first report from Thailand. Breast Cancer 2019; 26:471-477. [PMID: 30617675 DOI: 10.1007/s12282-019-00945-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/31/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Axillary staging is a significant prognostic factor often used to determine the treatment course for breast cancer. One-step nucleic acid amplification (OSNA) is now the most accepted method for intra-operative assessment of sentinel lymph nodes (SLN) as it can semi-quantitatively determine the tumor burden in these SLN. Axillary lymph node dissection (ALND) may be omitted in patients with limited disease in the axilla. The objective was to create nomogram for prediction of non-sentinel lymph node (NSLN) status using OSNA to avoid unnecessary ALND. PATIENTS AND METHODS Patients with invasive breast cancer T1-T3 and clinically negative axillary lymph nodes underwent SLN biopsy assessed by OSNA. The patients with positive SLN underwent ALND. Correlations between total tumor load (TTL), clinicopathological parameters, and NSLN status were analyzed by Chi square statistic and logistic regression. Model discrimination was evaluated using receiver-operating characteristic (ROC) analysis. RESULTS The total number of patients who underwent SLN biopsies was 278. There were 89 patients with positive SLN. NSLNs were positive in 40 patients. Larger tumor size, presence of lymphovascular invasion (LVI) and higher log TTL were independent factors that predicted positive NSLN. TTL can discriminate NSLN status with area under the ROC curve of 0.789 (95% CI 0.686-0.892). Two nomograms using different parameters obtained pre- and post-operatively can predict NSLN involvement with better area under the ROC curve (0.801, 95% CI 0.702-0.900 and 0.849, 95% CI 0.766-0.932, respectively). CONCLUSIONS Nomograms using results obtained via OSNA can predict NSLN status, as well as aid in deciding to omit the use of ALND.
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Affiliation(s)
- Doonyapat Sa-Nguanraksa
- Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road Bangkoknoi, Bangkok, 10700, Thailand
| | | | - Anchalee Kulprom
- Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road Bangkoknoi, Bangkok, 10700, Thailand
| | - Norasate Samarnthai
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road Bangkoknoi, Bangkok, 10700, Thailand
| | - Visnu Lohsiriwat
- Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road Bangkoknoi, Bangkok, 10700, Thailand
| | - Kampanart Nimpoonsri
- Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road Bangkoknoi, Bangkok, 10700, Thailand
| | - Pornchai O-Charoenrat
- Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road Bangkoknoi, Bangkok, 10700, Thailand.
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Umekita Y, Ohi Y, Iwaya O, Souda M, Sagara Y, Tamada S, Yotsumoto D, Tanimoto A. Maspin mRNA expression in sentinel lymph nodes predicts non-SLN metastasis in breast cancer patients with SLN metastasis. Histopathology 2018; 73:916-922. [PMID: 30035819 DOI: 10.1111/his.13718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/20/2018] [Indexed: 12/13/2022]
Abstract
AIMS Maspin is known to be a tumour suppressor protein, but its prognostic significance in breast cancer patients is controversial. There is no report focusing on maspin expression in metastatic carcinoma of sentinel lymph nodes (SLNs); we thus investigated maspin mRNA expression in SLNs using the remaining specimens after the one-step nucleic acid amplification (OSNA) assay. METHODS AND RESULTS Ninety-three breast cancer patients with SLNs metastasis detected by the OSNA assay were enrolled. All patients experienced additional axillary lymph nodes (LNs) dissection and all dissected LNs were examined histopathologically. Maspin mRNA expression in SLNs was detected in 49.5% (46 of 93) and was correlated significantly with the presence of non-SLN metastasis (P < 0.0001) and ≥4 LN metastases (P = 0.029). In a multivariate logistic analysis, maspin mRNA expression in SLNs (P = 0.0015) had the most significant effect on predicting non-SLN metastasis, followed by pathological tumour size (P = 0.0039) and lymphovascular invasion (P = 0.009). The status of maspin mRNA expression in SLNs was correlated significantly with that of maspin protein expression in the primary carcinoma (P < 0.0001). CONCLUSIONS This is the first study, to our knowledge, demonstrating that maspin mRNA expression in SLNs is an independent predictor of non-SLN metastasis and the presence of ≥4 LN metastases in breast cancer patients with SLN metastasis. The investigation of maspin mRNA expression in SLNs using the remaining specimens after the OSNA assay may be useful for predicting the further progression of metastatic carcinoma in breast cancer patients with SLNs metastasis.
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Affiliation(s)
- Yoshihisa Umekita
- Division of Organ Pathology, Department of Pathology, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yasuyo Ohi
- Department of Pathology, Sagara Hospital, Social Medical Corporation Hakuaikai, Kagoshima, Japan
| | - Orie Iwaya
- Department of Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masakazu Souda
- Department of Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yasuaki Sagara
- Department of Breast Surgical Oncology, Sagara Hospital, Social Medical Corporation Hakuaikai, Kagoshima, Japan
| | - Shugo Tamada
- Department of Breast Surgical Oncology, Sagara Hospital, Social Medical Corporation Hakuaikai, Kagoshima, Japan
| | - Daisuke Yotsumoto
- Department of Breast Surgical Oncology, Sagara Hospital, Social Medical Corporation Hakuaikai, Kagoshima, Japan
| | - Akihide Tanimoto
- Department of Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Shimazu K, Sato N, Ogiya A, Sota Y, Yotsumoto D, Ishikawa T, Nakamura S, Kinoshita T, Tsuda H, Ohi Y, Akiyama F, Noguchi S. Intraoperative Nomograms, Based on One-Step Nucleic Acid Amplification, for Prediction of Non-sentinel Node Metastasis and Four or More Axillary Node Metastases in Breast Cancer Patients with Sentinel Node Metastasis. Ann Surg Oncol 2018; 25:2603-2611. [PMID: 29978372 PMCID: PMC6097722 DOI: 10.1245/s10434-018-6633-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Indexed: 01/17/2023]
Abstract
Background One-step nucleic acid amplification (OSNA) for cytokeratin 19 messenger RNA is an intraoperative diagnostic procedure for the detection of lymph node metastasis. Objective This study aimed to construct intraoperative nomograms using OSNA for the prediction of non-sentinel lymph node (NSLN) metastasis and four or more axillary lymph node (ALN) metastases. Methods Of the 4736 breast cancer patients (T1-3, N0) who underwent sentinel lymph node (SLN) biopsy and had SLNs examined intraoperatively with OSNA, 623 with SLN metastasis treated with completion ALN dissection (cALND) were retrospectively analyzed, and were randomly divided into training (n = 312) and validation (n = 311) sets. Results Of the clinicopathological parameters available preoperatively and intraoperatively, the multivariate analysis of the training set revealed that clinical tumor size and total tumor load (TTL) determined by OSNA were significantly associated with NSLN metastasis, and that clinical tumor size, number of macrometastatic SLNs, and TTL were significantly associated with four or more ALN metastases. Nomograms for NSLN metastasis and four or more ALN metastases were constructed using these parameters, and their area under the receiver operating characteristic curve (AUC) of the validation set were both 0.70, with a diagnostic accuracy similar to that of previously reported postoperative nomograms. Conclusions We constructed intraoperative nomograms using OSNA for the prediction of NSLN metastasis and four or more ALN metastases. These nomograms are as accurate as the conventional postoperative nomograms and might be helpful for decision making regarding the indication for cALND or the choice of adjuvant chemotherapeutic regimens and radiation field. Electronic supplementary material The online version of this article (10.1245/s10434-018-6633-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kenzo Shimazu
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Nobuaki Sato
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Akiko Ogiya
- Department of Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshiaki Sota
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Yotsumoto
- Department of Breast Surgical Oncology, Hakuaikai Sagara Hospital, Kagoshima, Japan
| | - Takashi Ishikawa
- Department of Breast Oncology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | | | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College, Tokorozawa, Japan
| | - Yasuyo Ohi
- Department of Pathology, Hakuaikai Sagara Hospital, Kagoshima, Japan
| | - Futoshi Akiyama
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinzaburo Noguchi
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Martin-Marcuartu J, Alvarez-Perez R, Sousa Vaquero J, Jimenez-Hoyuela García J. Selective sentinel lymph node biopsy in male breast cancer. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2017.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Martin-Marcuartu JJ, Alvarez-Perez RM, Sousa Vaquero JM, Jimenez-Hoyuela García JM. Selective sentinel lymph node biopsy in male breast cancer. Rev Esp Med Nucl Imagen Mol 2017; 37:146-150. [PMID: 29246402 DOI: 10.1016/j.remn.2017.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/18/2017] [Accepted: 09/26/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the reproducibility of the sentinel lymph node (SLN) technique in male breast cancer. MATERIAL AND METHODS We retrospectively analysed 21 male patients diagnosed with breast cancer in our hospital from 2008 to 2016 with, at least, 18 months follow-up. Fifteen patients underwent selective sentinel lymph node biopsy (SLNB) following the usual protocols with peritumoral injection of 18.5-111MBq of 99mTc-nanocoloides and acquisition of planar images 2hours after the injection. In 2 cases it was necessary to perform a SPECT/CT to locate the SLN. Immunohistochemistry and molecular techniques (OSNA) were used for their analysis. Six patients did not undergo SLNB because they had pathological nodes or distant disease at the time of diagnosis. RESULTS SLNB was performed in 15 patients. The SLN was negative in 6 patients and positive in the remaining 9. Three patients with positive SLNB did not need axillary lymphadenectomy because of the low number of copies by molecular analysis OSNA. Axillary lymphadenectomy was performed in the remaining 6 patients with the result of 4 positive axillary lymphadenectomies and 2 that did not show further extension of the disease. CONCLUSIONS According to our experience, SLNB in males is a reproducible, useful, safe and reliable technique which avoids unnecessary axillary lymphadenectomy and prevents the appearance of undesirable effects.
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Affiliation(s)
- J J Martin-Marcuartu
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - R M Alvarez-Perez
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J M Sousa Vaquero
- Servicio de Ginecología y Obstetricia, Hospital Universitario Virgen del Rocío, Sevilla, España
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Shigematsu H, Ozaki S, Yasui D, Zaitsu J, Taniyama D, Saitou A, Kuraoka K, Yamashiro H, Taniyama K. Comparison of CK-IHC assay on serial frozen sections, the OSNA assay, and in combination for intraoperative evaluation of SLN metastases in breast cancer. Breast Cancer 2017; 25:191-197. [PMID: 29094254 PMCID: PMC5818575 DOI: 10.1007/s12282-017-0811-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/26/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intraoperative evaluations of sentinel lymph node (SLN) metastases are performed for providing appropriate and immediate axillary treatments in breast cancer patients who do not meet Z0011 criteria; however, standard intraoperative procedure has not yet been established. METHODS We consecutively performed intraoperative evaluation for SLN metastases using both a cytokeratin immunohistochemistry (CK-IHC) assay on serial frozen sections and a one-step nucleic acid amplification (OSNA) assay of the remaining whole node in patients with invasive breast cancer. In this article, we compared the intraoperative diagnostic ability of CK-IHC assay, the OSNA assay, and in combination. RESULTS Between August 2009 and May 2017, 1,103 SLNs from 499 consecutive clinically node-negative invasive breast cancers were intraoperatively evaluated for SLN metastases using an OSNA and CK-IHC assay. The detection rates of SLN metastases by the OSNA and CK-IHC assays and in combination were 11.8, 12.1, and 14.5%, respectively. The concordance rate between the intraoperative SLN findings of the OSNA and CK-IHC assays was 94.9% (95% confidence interval 93.6-96.2%). The false negative rate for the OSNA assay was 3.1% (30/973), including 3 (0.3%) macrometastases and 27 (2.8%) micrometastases, and for the CK-IHC assay was 2.7% (26/969), including 1 (0.1%) OSNA ++ and 25 (2.6%) OSNA +. CONCLUSIONS The CK-IHC assay and the OSNA assay have compatible diagnostic abilities in intraoperative evaluations for SLN metastases. The low incidence of false negative results with limited disease burden suggests that both assays can be reliable techniques for intraoperative diagnoses of SLN metastases in breast cancer patients.
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Affiliation(s)
- Hideo Shigematsu
- Department of Breast Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1, Aoyama-cho, Kure, Hiroshima, 737-0023, Japan.
| | - Shinji Ozaki
- Department of Breast Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1, Aoyama-cho, Kure, Hiroshima, 737-0023, Japan
| | - Daisuke Yasui
- Department of Breast Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1, Aoyama-cho, Kure, Hiroshima, 737-0023, Japan
| | - Junichi Zaitsu
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Daiki Taniyama
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Akihisa Saitou
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Kazuya Kuraoka
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | | | - Kiyomi Taniyama
- National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
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Fung V, Kohlhardt S, Vergani P, Zardin GJ, Williams NR. 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. Mol Clin Oncol 2017; 7:755-762. [PMID: 29142748 PMCID: PMC5666659 DOI: 10.3892/mco.2017.1404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/11/2017] [Indexed: 01/17/2023] Open
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.
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Affiliation(s)
- Victoria Fung
- Department of Breast and Plastic Surgery, Sheffield Breast Center, Royal Hallamshire Hospital, S10 2JF Sheffield, UK
| | - Stan Kohlhardt
- Department of Breast and Plastic Surgery, Sheffield Breast Center, Royal Hallamshire Hospital, S10 2JF Sheffield, UK
| | - Patricia Vergani
- Department of Histopathology, Royal Hallamshire Hospital, S10 2JF Sheffield, UK
| | - Gregory J. Zardin
- Department of Histopathology, Royal Hallamshire Hospital, S10 2JF Sheffield, UK
| | - Norman R. Williams
- Division of Surgery and Interventional Science, University College London, WC1E 6AU London, UK
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Cremades M, Torres M, Solà M, Navinés J, Pascual I, Mariscal A, Caballero A, Castellà E, Luna MÁ, Julián JF. Secondary node analysis as an indicator for axillary lymphadenectomy in breast cancer patients. Cir Esp 2017; 95:536-541. [PMID: 29033071 DOI: 10.1016/j.ciresp.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 08/15/2017] [Accepted: 08/18/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Currently, there is no agreement regarding if it would be necessary to perform an axillary lymph node dissection (ALND) in patients who have macrometastases in the sentinel lymph node (SLN). We studied the utility of the secondary node analysis (SN), defined as the following node after the SLN in an anatomical and lymphatic pathway, as a sign of malignant axillary involvement. METHODS An observational, retrospective and multicentre study was designed to assess the utility of the SN as a sign of axillary involvement. Among 2273 patients with breast cancer, a valid sample of 283 was obtained representing those who had the SN studied. Main endpoints of our study were: the SLN, the SN and the ALND histological pattern. Sensitivity, specificity and precision of the test were also calculated. RESULTS SN test, in cases with positive SLN, has a sensitivity of 61.1%, a specificity of 78.7%, a positive predictive value of 45.8% and a negative predictive value of 87.3% with a precision of 74.7%. CONCLUSION The study of the SN together with the technique of the SLN allows a more precise staging of the axillary involvement, in patients with breast cancer, than just the SLN technique.
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Affiliation(s)
- Manel Cremades
- Cirugía General y Digestiva, Hospital Germans Trias i Pujol, Badalona, España.
| | - Mireia Torres
- Cirugía General y Digestiva, Hospital General de Catalunya, Sant Cugat del Vallés, España
| | - Montse Solà
- Medicina Nuclear, Hospital Germans Trias i Pujol, Badalona
| | - Jordi Navinés
- Cirugía General y Digestiva, Hospital Germans Trias i Pujol, Badalona, España
| | - Icíar Pascual
- Cirugía General y Digestiva, Hospital Germans Trias i Pujol, Badalona, España
| | | | - Albert Caballero
- Cirugía General y Digestiva, Hospital Germans Trias i Pujol, Badalona, España
| | - Eva Castellà
- Anatomía Patológica, Hospital Germans Trias i Pujol, Badalona, España
| | - Miguel Ángel Luna
- Ginecología y Obstetricia, Hospital Germans Trias i Pujol, Badalona, España
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Peg V, Sansano I, Vieites B, Bernet L, Cano R, Córdoba A, Sancho M, Martín MD, Vilardell F, Cazorla A, Espinosa-Bravo M, Pérez-García JM, Cortés J, Rubio IT, Ramón y Cajal S. Role of total tumour load of sentinel lymph node on survival in early breast cancer patients. Breast 2017; 33:8-13. [DOI: 10.1016/j.breast.2017.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/18/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022] Open
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Nabais C, Figueiredo J, Lopes P, Martins M, Araújo A. Total tumor load assessed by one-step nucleic acid amplification assay as an intraoperative predictor for non-sentinel lymph node metastasis in breast cancer. Breast 2017; 32:33-36. [DOI: 10.1016/j.breast.2016.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/01/2016] [Accepted: 12/19/2016] [Indexed: 01/04/2023] Open
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A cut-off of 2150 cytokeratin 19 mRNA copy number in sentinel lymph node may be a powerful predictor of non-sentinel lymph node status in breast cancer patients. PLoS One 2017; 12:e0171517. [PMID: 28187209 PMCID: PMC5302783 DOI: 10.1371/journal.pone.0171517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 01/16/2017] [Indexed: 01/03/2023] Open
Abstract
Since 2007, one-step nucleic acid amplification (OSNA) has been used as a diagnostic system for sentinel lymph node (SLN) examination in patients with breast cancer. This study aimed to define a new clinical cut-off of CK19 mRNA copy number based on the calculation of the risk that an axillary lymph node dissection (ALND) will be positive. We analyzed 1529 SLNs from 1140 patients with the OSNA assay and 318 patients with positive SLNs for micrometastasis (250 copies) and macrometastasis (5000 copies) underwent ALND. Axillary non–SLNs were routinely examined. ROC curves and Youden’s index were performed in order to identify a new cut-off value. Logistic regression models were performed in order to compare OSNA categorical variables created on the basis of our and traditional cut-off to better identify patients who really need an axillary dissection. 69% and 31% of OSNA positive patients had a negative and positive ALND, respectively. ROC analysis identified a cut-off of 2150 CK19 mRNA copies with 95% sensitivity and 51% specificity. Positive and negative predictive values of this new cut-off were 47% and 96%, respectively. Logistic regression models indicated that the cut-off of 2150 copies better discriminates patients with node negative or positive in comparison with the conventional OSNA cut-off (p<0.0001). This cut-off identifies false positive and false negative cases and true-positive and true negative cases very efficiently, and therefore better identifies which patients really need an ALND and which patients can avoid one. This is why we suggest that the negative cut-off should be raised from 250 to 2150. Furthermore, we propose that for patients with a copy number that ranges between 2150 and 5000, there should be a multidisciplinary discussion concerning the clinical and bio-morphological features of primary breast cancer before any decision is taken on whether to perform an ALND or not.
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Rakislova N, Montironi C, Aldecoa I, Fernandez E, Bombi JA, Jimeno M, Balaguer F, Pellise M, Castells A, Cuatrecasas M. Lymph node pooling: a feasible and efficient method of lymph node molecular staging in colorectal carcinoma. J Transl Med 2017; 15:14. [PMID: 28088238 PMCID: PMC5237515 DOI: 10.1186/s12967-016-1114-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/22/2016] [Indexed: 01/11/2023] Open
Abstract
Background Pathologic lymph node staging is becoming a deficient method in the demanding molecular era. Nevertheless, the use of more sensitive molecular analysis for nodal staging is hampered by its high costs and extensive time requirements. Our aim is to take a step forward in colon cancer (CC) lymph node (LN) pathology diagnosis by proposing a feasible and efficient molecular method in routine practice using reverse transcription loop-mediated isothermal amplification (RT-LAMP). Results Molecular detection of tumor cytokeratin 19 (CK19) mRNA with RT-LAMP was performed in 3206 LNs from 188 CC patients using two methods: individual analysis of 1449 LNs from 102 patients (individual cohort), and pooled LN analysis of 1757 LNs from 86 patients (pooling cohort). A median of 13 LNs (IQR 10–18) per patient were harvested in the individual cohort, and 18 LNs (IQR 13–25) per patient in the pooling cohort (p ≤ 0.001). The median of molecular assays performed in the pooling cohort was 2 per patient (IQR 1–3), saving a median of 16 assays/patient. The number of molecular assays performed in the individual cohort was 13 (IQR 10–18), corresponding to the number of LNs to be analyzed. The sensitivity and specificity of the pooling method for LN involvement (assessed by hematoxylin and eosin) were 88.9% (95% CI 56.5–98.0) and 79.2% (95% CI 68.9–86.8), respectively; concordance, 80.2%; PPV, 33.3%; NPV, 98.4%. The individual method had 100% sensitivity (95% CI 72.2–100), 44.6% specificity (95% CI 34.8–54.7), 50% concordance, 16.4% PPV, and 100% NPV. The amount of tumor burden detected in all LNs of a case, or total tumor load (TTL) was similar in both cohorts (p = 0.228). Conclusions LN pooling makes it possible to analyze a high number of LNs from surgical colectomies with few molecular tests per patient. This approach enables a feasible means to integrate LN molecular analysis from CC specimens into pathology diagnosis and provides a more accurate LN pathological staging with potential prognostic implications.
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Affiliation(s)
- Natalia Rakislova
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain
| | - Carla Montironi
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain
| | - Iban Aldecoa
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain
| | - Eva Fernandez
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain
| | - Josep Antoni Bombi
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain
| | - Mireya Jimeno
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Maria Pellise
- Gastroenterology Department, Hospital Clinic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain. .,Tumor Bank, Biobanc Clinic-IDIBAPS and Xarxa de Bancs de Tumors de Catalunya (XBTC), Barcelona, Spain.
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Parada D, Peña KB, Riu FF, Aguilar AE, Cohan S. Intraoperative molecular analysis of sentinel lymph nodes following neoadjuvant chemotherapy in patients with clinical node negative breast cancer: An institutional study. Mol Clin Oncol 2016; 5:507-510. [PMID: 27882235 PMCID: PMC5103850 DOI: 10.3892/mco.2016.1025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/25/2016] [Indexed: 11/11/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is an accurate, safe method for determining the axillary lymph node status. However, insufficient evidence exists to support the recommendation of SLNB in patients who have had neoadjuvant chemotherapy (NAC) to downsize tumours and allow for breast conservation surgery. The present study aimed to use molecular approaches to evaluate the feasibility and accuracy of SLNB in patients treated with NAC prior to SLN mapping and surgery. A total of 50 consecutive patients with operable invasive breast carcinomas who had received prior NAC were assessed using the one-step nucleic acid amplification (OSNA) method. The rate of SLN identification was 100%. The OSNA assay showed that 29 patients (58%) were negative for SLN and 21 patients (42%) were positive. In 19 of these 21 patients (90.48%), the SLN was the only positive lymph node. No axillary lymph nodes metastases were observed in patients with isolated tumour cells or with micrometastases. The OSNA assay is a highly sensitive, specific and reproducible diagnostic technique that can be used to analyse SLNs following NAC. The total tumoral load may assist with predicting additional non-SLN metastases.
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Affiliation(s)
- David Parada
- Department of Pathology, University Hospital Sant Joan de Reus, University Rovira i Virgill, E-43201 Tarragona, Spain
- Pere Virgili Health Research Institute (IISPV), University Rovira i Virgill, E-43201 Tarragona, Spain
| | - Karla B. Peña
- Department of Pathology, University Hospital Sant Joan de Reus, University Rovira i Virgill, E-43201 Tarragona, Spain
- Pere Virgili Health Research Institute (IISPV), University Rovira i Virgill, E-43201 Tarragona, Spain
| | - F. Francesc Riu
- Department of Pathology, University Hospital Sant Joan de Reus, University Rovira i Virgill, E-43201 Tarragona, Spain
- Pere Virgili Health Research Institute (IISPV), University Rovira i Virgill, E-43201 Tarragona, Spain
| | - A. Esther Aguilar
- Department of Gynecology, University Hospital Sant Joan de Reus, E-43204 Tarragona, Spain
| | - Sebastian Cohan
- Department of Radiodiagnostics, University Hospital Sant Joan de Reus, E-43204 Tarragona, Spain
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One-step nucleic acid amplification (OSNA): where do we go with it? Int J Clin Oncol 2016; 22:3-10. [DOI: 10.1007/s10147-016-1030-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/08/2016] [Indexed: 12/29/2022]
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50
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Aldecoa I, Atares B, Tarragona J, Bernet L, Sardon JD, Pereda T, Villar C, Mendez MC, Gonzalez-Obeso E, Elorriaga K, Alonso GL, Zamora J, Planell N, Palacios J, Castells A, Matias-Guiu X, Cuatrecasas M. Molecularly determined total tumour load in lymph nodes of stage I-II colon cancer patients correlates with high-risk factors. A multicentre prospective study. Virchows Arch 2016; 469:385-94. [PMID: 27447172 PMCID: PMC5033997 DOI: 10.1007/s00428-016-1990-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/17/2016] [Accepted: 07/07/2016] [Indexed: 01/11/2023]
Abstract
Stage I–II (pN0) colorectal cancer patients are surgically treated although up to 25 % will eventually die from disease recurrence. Lymph node (LN) status is an independent prognostic factor in colorectal cancer (CRC), and molecular tumour detection in LN of early-stage CRC patients is associated with an increased risk of disease recurrence and poor survival. This prospective multicentre study aimed to determine the relationship between LN molecular tumour burden and conventional high-risk factors in stage I–II colon cancer patients. A total of 1940 LN from 149 pathologically assessed pN0 colon cancer patients were analysed for the amount of tumour cytokeratin 19 (CK19) messenger RNA (mRNA) with the quantitative reverse transcription loop-mediated isothermal amplification molecular assay One-Step Nucleic Acid Amplification. Patient’s total tumour load (TTL) resulted from the sum of all CK19 mRNA tumour copies/μL of each positive LN from the colectomy specimen. A median of 15 LN were procured per case (IQR 12;20). Molecular positivity correlated with high-grade (p < 0.01), mucinous/signet ring type (p = 0.017), male gender (p = 0.02), number of collected LN (p = 0.012) and total LN weight per case (p < 0.01). The TTL was related to pT stage (p = 0.01) and tumour size (p < 0.01) in low-grade tumours. Multivariate logistic regression showed independent correlation of molecular positivity with gender, tumour grade and number of fresh LN [AUC = 0.71 (95 % CI = 0.62–0.79)]. Our results show that lymph node CK19 mRNA detection correlates with classical high-risk factors in stage I–II colon cancer patients. Total tumour load is a quantitative and objective measure that may help to better stage early colon cancer patients.
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Affiliation(s)
- Iban Aldecoa
- Pathology Department, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5. Villarroel 170, Barcelona, 08036, Spain
| | - Begoña Atares
- Pathology Department, Alava University Hospital, Vitoria-Gasteiz, Spain
| | - Jordi Tarragona
- Pathology Department, Hospital Arnau de Vilanova, Lleida, Spain
| | - Laia Bernet
- Pathology Department, Hospital L. Alcanyis, Xativa, Spain
| | | | - Teresa Pereda
- Pathology Department, Hospital Costa del Sol, Marbella, Spain
| | - Carlos Villar
- Pathology Department, Hospital Reina Sofia, Cordoba, Spain
| | - M Carmen Mendez
- Pathology Department, Hospital Severo Ochoa, Leganes, Madrid, Spain
| | | | - Kepa Elorriaga
- Pathology Department, Hospital Onkologikoa, San Sebastian, Spain
| | | | - Javier Zamora
- Biostatistic Unit, Hospital Ramon y Cajal, Madrid, Spain
| | - Nuria Planell
- Gastroenterology Department and Bioinformatics Unit, CIBERehd, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jose Palacios
- Pathology Department, Hospital Ramon y Cajal, Madrid, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | - Miriam Cuatrecasas
- Pathology Department, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5. Villarroel 170, Barcelona, 08036, Spain.
- CIBERehd, and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Hospital Clinic, Barcelona, Spain.
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