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Yang L, Zhao X, Yang L, Chang Y, Cao C, Li X, Wang Q, Song Z. A new prediction nomogram of non-sentinel lymph node metastasis in cT1-2 breast cancer patients with positive sentinel lymph nodes. Sci Rep 2024; 14:9596. [PMID: 38671007 PMCID: PMC11053028 DOI: 10.1038/s41598-024-60198-0] [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: 01/14/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
We aimed to analyze the risk factors and construct a new nomogram to predict non-sentinel lymph node (NSLN) metastasis for cT1-2 breast cancer patients with positivity after sentinel lymph node biopsy (SLNB). A total of 830 breast cancer patients who underwent surgery between 2016 and 2021 at multi-center were included in the retrospective analysis. Patients were divided into training (n = 410), internal validation (n = 298), and external validation cohorts (n = 122) based on periods and centers. A nomogram-based prediction model for the risk of NSLN metastasis was constructed by incorporating independent predictors of NSLN metastasis identified through univariate and multivariate logistic regression analyses in the training cohort and then validated by validation cohorts. The multivariate logistic regression analysis revealed that the number of positive sentinel lymph nodes (SLNs) (P < 0.001), the proportion of positive SLNs (P = 0.029), lymph-vascular invasion (P = 0.029), perineural invasion (P = 0.023), and estrogen receptor (ER) status (P = 0.034) were independent risk factors for NSLN metastasis. The area under the receiver operating characteristics curve (AUC) value of this model was 0.730 (95% CI 0.676-0.785) for the training, 0.701 (95% CI 0.630-0.773) for internal validation, and 0.813 (95% CI 0.734-0.891) for external validation cohorts. Decision curve analysis also showed that the model could be effectively applied in clinical practice. The proposed nomogram estimated the likelihood of positive NSLNs and assisted the surgeon in deciding whether to perform further axillary lymph node dissection (ALND) and avoid non-essential ALND as well as postoperative complications.
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Affiliation(s)
- Liu Yang
- Department of Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Xueyi Zhao
- Department of Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Lixian Yang
- Department of Breast Surgery, Xingtai People's Hospital, Xingtai, 054000, China
| | - Yan Chang
- Department of Breast Surgery, Affiliated Hospital of Hebei Engineering University, Handan, 056000, China
| | - Congbo Cao
- Department of Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Xiaolong Li
- Department of Breast Surgery, The Fourth Hospital of Shijiazhuang, Shijiazhuang, 050000, China
| | - Quanle Wang
- Department of Breast Surgery, The Fourth Hospital of Shijiazhuang, Shijiazhuang, 050000, China
| | - Zhenchuan Song
- Department of Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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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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van Haaren ERM, Poodt IGM, Spiekerman van Weezelenburg MA, van Bastelaar J, Janssen A, de Vries B, Lobbes MBI, Bouwman LH, Vissers YLJ. Impact of analysis of the sentinel lymph node by one-step nucleic acid amplification (OSNA) compared to conventional histopathology on axillary and systemic treatment: data from the Dutch nationwide cohort of breast cancer patients. Breast Cancer Res Treat 2023; 202:245-255. [PMID: 37495799 PMCID: PMC10505596 DOI: 10.1007/s10549-023-07065-0] [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: 02/23/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE The outcome of the sentinel lymph node in breast cancer patients affects adjuvant treatment. Compared to conventional histopathology, analysis by one-step nucleic acid amplification (OSNA) harvests more micrometastasis, potentially inducing overtreatment. In this study we investigated the impact of OSNA analysis on adjuvant treatment, compared to histopathological analysis. METHODS Data from T1-3 breast cancer patients with sentinel nodes analysed between January 2016 and December 2019 by OSNA (OSNA group, n = 1086) from Zuyderland Medical Centre, the Netherlands, were compared to concurrent data from the Netherlands Cancer Registry (NKR) where sentinel nodes were examined by histology (histology group, n = 35,143). Primary outcomes were micro- or macrometastasis, axillary treatments (axillary lymph node dissection (ALND) or axillary radiotherapy (ART)), chemotherapy, and endocrine therapy. Statistics with Pearson Chi-square. RESULTS In the OSNA group more micrometastasis (14.9%) were detected compared to the histology group (7.9%, p < 0.001). No difference in axillary treatment between groups was detected (14.3 vs. 14.4%). In case of mastectomy and macrometastasis, ALND was preferred over ART in the OSNA group (14.9%) compared to the histology group (4.4%, p < 0.001). In cases of micrometastasis, no difference was seen. There was no difference in administration of adjuvant chemotherapy between groups. Endocrine treatment was administrated less often in the OSNA group compared to the histology group (45.8% vs. 50.8%, p < 0.002). CONCLUSION More micrometastasis were detected by OSNA compared to histopathology, but no subsequent increase in adjuvant axillary and systematic treatment was noticed. When performing mastectomy and OSNA, there was a preference for ALND compared to ART.
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Affiliation(s)
- Elisabeth R M van Haaren
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands.
| | - Ingrid G M Poodt
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
| | | | - James van Bastelaar
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
| | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
| | - Bart de Vries
- Department of Pathology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Lee H Bouwman
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
- Department of Clinical Engineering, Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
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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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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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Sousa N, Peleteiro B, Fougo JL. Total Tumor Load to assist in the decision for additional axillary surgery in the positive sentinel node breast cancer patients. Surg Oncol 2022; 45:101882. [PMID: 36395579 DOI: 10.1016/j.suronc.2022.101882] [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: 08/11/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
The Total Tumor Load (TTL) concept has been demonstrated to accurately predict the status of the non-sentinel lymph nodes (NSLN) in breast cancer patients. In 2019, our center implemented the TTL cut-off of 30,000 CK19 mRNA copies/μL as sole criterion for deciding on performing ALND. This retrospective, unicentric, study analyzed 87 cT1-3N0 breast cancer patients treated consecutively in a period of two years and aimed to evaluate the performance of this criterion. Secondary objectives included the comparison of the criterion versus our previous Clinical Decision Rule (CDR) versus ACOSOG Z0011 criteria for avoiding an ALND in proportion of patients spared an ALND and in proportion of patients left with a surgically untreated metastasized axilla. An interim analysis revealed new TTL cut-offs for deciding on performing an ALND. The 30,000 CK19 mRNA copies/μL criterion yielded an area under the ROC Curve (AUC) of 0.849, a false positive (FP) rate of 30.1% and a positive predictive value (PPV) of 38.9%. The 30,000 CK19 mRNA copies/μL criterion spared 58.6% of the patients an ALND versus 41.4% with CDR versus 73.6% with Z0011 and left 0.0% patients with a surgically untreated metastasized axilla versus 21.4% with CDR versus 42.9% with Z0011. The new TTL cut-off of 260,000 CK19 mRNA copies/μL for deciding on an ALND yielded an AUC of 0.753, a FP rate of 13.7% and a PPV of 47.4%. This new criterion spared 78.2% of the study sample an ALND and left 35.7% of metastasized axillae surgically untreated. This study emphasizes the need to find a new balance between locoregional control and the morbidity associated with Berg levels I + II axillary lymph node dissection.
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Affiliation(s)
- Nuno Sousa
- Faculty of Medicine, University of Porto, Portugal.
| | - Bárbara Peleteiro
- Faculty of Medicine, University of Porto, Portugal; Breast Center, Centro Hospitalar Universitário São João, Porto, Portugal; EPI Unit, Institute of Public Health, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health, University of Porto, Portugal.
| | - José Luis Fougo
- Breast Center, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal.
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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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Beato Tortajada I, Ferrer Albiach C, Morillo Macias V. Nomogram for the personalisation of radiotherapy treatments in breast cancer patients. Breast 2021; 60:255-262. [PMID: 34808437 PMCID: PMC8609093 DOI: 10.1016/j.breast.2021.11.004] [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: 05/07/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Numerous prospective studies have shown that the incorporation of genomic assays into clinical practice significantly impacts the choice of adjuvant treatments for patients with early-stage breast cancer. However, the same evidence does not exist for the treatment of locoregional recurrences. Hypothesis and objectives The main objective of this work was to identify the clinicopathological, molecular, and genetic parameters that allow patients to be more precisely categorised into risk groups, in order to create a locoregional recurrence riskclassification tool, the PersonalRT27. Material and methods To create PersonalRT27, we retrospective assessed the variables of patients with early breast cancer (stages I or II) who had undergone the OncotypeDx ® and MammaPrint ® genetic tests. These variables and factors included in the tests were categorised and weighted to obtain scores between 1 and 5 pointsto represent a lower or higher risk of relapse, respectively, based on these factors and as determined by the researchers. Results The mean follow-up time was 60.5 months (range 25–96 months); locoregional progression-free survival at the time of the analysis was 98.4%, and overall survival was 97.5%, of which 0.6% of the deaths had been cancer specific. The area under the curve for the PersonalRT27 was 0.76 (95% CI [0.70, 0.81]), sensitivity was 78%, and the specificity was 58.9%. We used these factors to create an inhospital web-based nomogram. Conclusions The PersonalRT27 is a novel tool that integrates clinical-pathological, molecular, and genetic parameters. External and independent validation will be required to implement its clinical use. Genomic assays impact the choice of adjuvant systemic treatment for patients with early-stage breast cancer. However, the same evidence does not exist for decision making regarding adjuvant locoregional therapy. In other words, can the clinically approved genomic assays predict the risk of locoregional recurrende as a primary event. The main objective of this work was to identify the clinicopathological, molecular, and genetic parameters that allow patients to be more precisely categorised into risk groups, in order to create a locoregional recurrence risk-classification tool, the PersonalRT27.
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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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Archilla I, Díaz-Mercedes S, Aguirre JJ, Tarragona J, Machado I, Rodrigo MT, Lopez-Prades S, Gorostiaga I, Landolfi S, Alén BO, Balaguer F, Castells A, Camps J, Cuatrecasas M. Lymph Node Tumor Burden Correlates With Tumor Budding and Poorly Differentiated Clusters: A New Prognostic Factor in Colorectal Carcinoma? Clin Transl Gastroenterol 2021; 12:e00303. [PMID: 33939382 PMCID: PMC7909319 DOI: 10.14309/ctg.0000000000000303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Molecular lymph node (LN) staging in early colorectal cancer (CRC) has demonstrated to be more precise than conventional histopathology pN staging. Tumor budding (TB) and poorly differentiated clusters (PDCs) are associated with LN metastases, recurrences, and lower survival in CRC. We evaluated the correlation between the total tumor load (TTL) in LNs from CRC surgical specimens with patient outcome, TB, and PDC. METHODS In this retrospective multicentre study, 5,931 LNs from 342 stage I-III CRC were analyzed by both hematoxylin and eosin and molecular detection of tumor cytokeratin 19 mRNA by one-step nucleic acid amplification. TB and PDC were evaluated by hematoxylin and eosin and cytokeratin 19 immunohistochemistry. RESULTS One-step nucleic acid was positive in 38.3% patients (n = 131). Tumor Budding was low in 45% cases, intermediate in 25%, and high in 30%. Poorly Differentiated Clusters were low-grade G1 in 53%, G2 in 32%, and G3 in 15%. TB and PDC correlated with TTL, high-grade, lymphovascular and perineural invasion, pT, pN and stage (P < 0.001). TB, PDC, and TTL ≥ 6,000 copies/µL were associated with worse overall survival (P = 0.002, P = 0.013, and P = 0.046) and disease-free survival (P < 0.001). DISCUSSION The implementation of more sensitive molecular methods to assess LN status is a promising alternative approach to pN staging, which could be integrated to other factors to help risk stratification and management of patients with early-stage CRC. This study demonstrates the correlation of the amount of LN tumor burden with TB and PDCs. TTL is related to the outcome and could be used as a new prognostic factor in CRC (see Visual Abstract, Supplementary Digital Content 2, http://links.lww.com/CTG/A512).
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Affiliation(s)
- Ivan Archilla
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
| | - Sherley Díaz-Mercedes
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
| | | | - Jordi Tarragona
- Pathology Department, Hospital Arnau de Vilanova, Lleida, Spain
| | - Isidro Machado
- Pathology Department, Instituto Valenciano de Oncologia and Hospital QuironSalud, Valencia, Spain
| | - Maria Teresa Rodrigo
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
| | - Sandra Lopez-Prades
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
| | - Iñigo Gorostiaga
- Pathology Department, Arava University Hospital, Vitoria-Gasteiz, Spain
| | - Stefania Landolfi
- Pathology Department, Vall Hebron University Hospital, Barcelona, Spain
| | - Begoña Otero Alén
- Molecular Pathology Division, Pathology Department, CHUAC/INIBIC, A Coruña, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red. Enfermedades Hepáticas y Digestivas (CIBERehd). ISCiii. Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red. Enfermedades Hepáticas y Digestivas (CIBERehd). ISCiii. Spain
| | - Jordi Camps
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red. Enfermedades Hepáticas y Digestivas (CIBERehd). ISCiii. Spain
| | - Miriam Cuatrecasas
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
- Centro de Investigación Biomédica en Red. Enfermedades Hepáticas y Digestivas (CIBERehd). ISCiii. Spain
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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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12
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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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13
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Hintzen KFH, de Rooij L, Schouten N, van Bastelaar J, Cörvers SAJ, Janssen A, van Haaren ERM, Vissers YLJ. Molecular analysis of sentinel lymph nodes in patients with breast cancer using one-step nucleic acid amplification (OSNA): Does not lead to overtreatment in the current era of de-escalating axillary management. Surg Oncol 2020; 35:224-228. [PMID: 32932218 DOI: 10.1016/j.suronc.2020.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/24/2020] [Accepted: 09/07/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE OSNA is a molecular technique for sentinel lymph node (SN) analysis in breast cancer. Compared to histology, OSNA may yield more (micro)metastases and thereby result in more axillary lymph node dissections or radiotherapy. We investigated whether axillary treatments increase when using OSNA, applying current guidelines for de-escalating axillary management. METHODS All patients treated for cT1-3N0 breast cancer in our hospital between December 2013 and February 2016 were included. In 148 prospectively included patients (January 2015-February 2016), SN's were examined with OSNA. In a retrospective cohort of 123 patients (December 2013-December 2014), SN's were examined with conventional histology. Outcomes were: number of macro and micrometastases, amount of patients receiving axillary dissection or irradiation, number of patients receiving adjuvant systemic therapy. Data were analyzed using Mann-Whitney and Pearson Chi-square test. P < 0.05 was considered statistically significant. RESULTS 230 SN's from 123 patients were examined with conventional histology. 229 SN's from 148 patients were evaluated with OSNA. Amount of macrometastases was equal between groups (histology 17.9% versus OSNA 16.2%, p = 0.715). We found significantly more micrometastases when using OSNA (histology 11.4% versus OSNA 25.0%, p = 0.004). Total number of axillary lymph node dissections was comparable in both groups (histology 12.2%, OSNA 12.2%, p = 0.993), as well as number of axillary radiations (histology 8.9%, OSNA 11.5%, p = 0.493). Also, the number of patients receiving adjuvant systemic therapy was similar between conventional histology and OSNA (histology 53.7% versus OSNA 58.1%, p = 0.462). CONCLUSION OSNA analysis for SN in breast cancer is a highly sensitive technique, detecting more micrometastases than standard histology. When applying current guidelines, OSNA analysis does not lead to overtreatment with more axillary dissections or irradiation.
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Affiliation(s)
- K F H Hintzen
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - L de Rooij
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands.
| | - N Schouten
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - J van Bastelaar
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - S A J Cörvers
- Department of Pathology, Zuyderland Medical Center, Sittard, the Netherlands
| | - A Janssen
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - E R M van Haaren
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - Y L J Vissers
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands.
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14
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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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15
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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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16
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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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17
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Abe M, Kagara N, Miyake T, Tanei T, Naoi Y, Shimoda M, Shimazu K, Kim SJ, Noguchi S. Highly sensitive detection of sentinel lymph node metastasis of breast cancer by digital PCR for RASSF1A methylation. Oncol Rep 2019; 42:2382-2389. [PMID: 31638213 PMCID: PMC6826319 DOI: 10.3892/or.2019.7363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/19/2019] [Indexed: 12/19/2022] Open
Abstract
One-step nucleic acid amplification (OSNA) targeting cytokeratin 19 (CK19) mRNA expression and pathological examination are widely used for the intraoperative diagnosis of sentinel node (SN) metastasis. The aim of the present study was to develop a novel assay for detecting SN metastasis by targeting Ras association domain-containing protein 1 (RASSF1A) methylation in tumor cells, and to compare its performance with OSNA. Using digital PCR with methylation-specific restriction enzymes (RE-dMSP), our assay was able to detect ≥3 copies of methylated DNA per well, and was ≥10 times more sensitive than real-time PCR with bisulfite modification. OSNA lysates were examined using RE-dMSP and digital PCR for PIK3CA mutation, in the event that primary tumors were PIK3CA mutation-positive. RE-dMSP revealed a high concordance of 95.0% (153/161) with OSNA, and 100% (59/59) with PIK3CA mutation for detecting SN metastasis. In 11 breast cancer cell lines, the variation in methylated RASSF1A copy number was significantly lower than that of CK19 mRNA (2.8 vs. 10.5-fold; P<0.01). RE-dMSP has the potential to more accurately detect SN metastasis, and to more precisely estimate total tumor loads in SN, compared with OSNA.
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Affiliation(s)
- Mizuho Abe
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565‑0871, Japan
| | - Naofumi Kagara
- 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
| | - Yasuto Naoi
- 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
| | - Kenzo Shimazu
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565‑0871, Japan
| | - Seung Jin Kim
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565‑0871, Japan
| | - Shinzaburo Noguchi
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565‑0871, Japan
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18
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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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20
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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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Hunter-Smith AE, Rayter Z. One-step nucleic acid amplification: the possible value in assessing sentinel lymph node metastasis during mastectomy. BREAST CANCER (DOVE MEDICAL PRESS) 2018; 10:13-21. [PMID: 29416374 PMCID: PMC5790072 DOI: 10.2147/bctt.s113737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Breast cancer is the most common cancer in women, worldwide, and 1,400 deaths per day are attributed to it. The success of national screening programs has seen breast cancers being diagnosed at an earlier stage. With conservative surgery to the breast demonstrating equivalent long-term outcomes, the last 10 years have seen a growing interest in the safety of less invasive management for the axilla in breast cancer patients. One-step nucleic acid amplification (OSNA) is a validated, reliable, and efficient tool in identifying micro- and macro-metastases intraoperatively. It is the most widely used intraoperative analysis tool within the United Kingdom, and is employed by over 320 units across Europe and Asia. Recent evidence from the AMAROS, IBCSG 23-01, and ACOSOG Z0011 trials has changed surgical practice in managing the axilla of patients with breast cancer. We propose a clinical algorithm demonstrating the role of OSNA as an intraoperative analysis tool in today's management of breast cancer as well as prospects for the future use of OSNA.
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Affiliation(s)
- Alison E Hunter-Smith
- Breast Surgery Unit, Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Zenon Rayter
- Breast Surgery Unit, Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, UK
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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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Abstract
CONTEXT -Sentinel lymph node biopsy has been established as the new standard of care for axillary staging in most patients with invasive breast carcinoma. Historically, all patients with a positive sentinel lymph node biopsy result underwent axillary lymph node dissection. Recent trials show that axillary lymph node dissection can be safely omitted in women with clinically node negative, T1 or T2 invasive breast cancer treated with breast-conserving surgery and whole-breast radiotherapy. This change in practice also has implications on the pathologic examination and reporting of sentinel lymph nodes. OBJECTIVE -To review recent clinical and pathologic studies of sentinel lymph nodes and explore how these findings influence the pathologic evaluation of sentinel lymph nodes. DATA SOURCES -Sources were published articles from peer-reviewed journals in PubMed (US National Library of Medicine) and published guidelines from the American Joint Committee on Cancer, the Union for International Cancer Control, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network. CONCLUSIONS -The main goal of sentinel lymph node examination should be to detect all macrometastases (>2 mm). Grossly sectioning sentinel lymph nodes at 2-mm intervals and evaluation of one hematoxylin-eosin-stained section from each block is the preferred method of pathologic evaluation. Axillary lymph node dissection can be safely omitted in clinically node-negative patients with negative sentinel lymph nodes, as well as in a selected group of patients with limited sentinel lymph node involvement. The pathologic features of the primary carcinoma and its sentinel lymph node metastases contribute to estimate the extent of non-sentinel lymph node involvement. This information is important to decide on further axillary treatment.
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Affiliation(s)
| | - Edi Brogi
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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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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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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Omission of axillary dissection after a positive sentinel lymph-node: Implications in the multidisciplinary treatment of operable breast cancer. Cancer Treat Rev 2016; 48:1-7. [DOI: 10.1016/j.ctrv.2016.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/08/2016] [Accepted: 05/12/2016] [Indexed: 02/06/2023]
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Saruta Y, Puig-Junoy J. Cost and Budget Impact Analysis of an Accurate Intraoperative Sentinel Lymph Node Diagnosis for Breast Cancer Metastasis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:323-35. [PMID: 27043330 DOI: 10.1007/s40258-016-0235-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Conventional intraoperative sentinel lymph node biopsy (SLNB) in breast cancer (BC) has limitations in establishing a definitive diagnosis of metastasis intraoperatively, leading to an unnecessary second operation. The one-step nucleic amplification assay (OSNA) provides accurate intraoperative diagnosis and avoids further testing. Only five articles have researched the cost and cost effectiveness of this diagnostic tool, although many hospitals have adopted it, and economic evaluation is needed for budget holders. OBJECTIVE We aimed to measure the budget impact in Japanese BC patients after the introduction of OSNA, and assess the certainty of the results. METHODS Budget impact analysis of OSNA on Japanese healthcare expenditure from 2015 to 2020. Local governments, society-managed health insurers, and Japan health insurance associations were the budget holders. In order to assess the cost gap between the gold standard (GS) and OSNA in intraoperative SLNB, a two-scenario comparative model that was structured using the clinical pathway of a BC patient group who received SLNB was applied. Clinical practice guidelines for BC were cited for cost estimation. RESULTS The total estimated cost of all BC patients diagnosed by GS was US$1,023,313,850. The budget impact of OSNA in total health expenditure was -US$24,413,153 (-US$346 per patient). Two-way sensitivity analysis between survival rate (SR) of the GS and OSNA was performed by illustrating a cost-saving threshold: y ≅ 1.14x - 0.16 in positive patients, and y ≅ 0.96x + 0.029 in negative patients (x = SR-GS, y = SR-OSNA). Base inputs of the variables in these formulas demonstrated a cost saving. CONCLUSION OSNA reduces healthcare costs, as confirmed by sensitivity analysis.
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Affiliation(s)
- Yuko Saruta
- Barcelona School of Management, Pompeu Fabra University, C. Ramón Trias Fargas 25-27, Edificio Jaume I, Barcelona, 08005, Spain.
| | - Jaume Puig-Junoy
- Department of Economics and Business, Research Centre for Health and Economics (CRES), Pompeu Fabra University, Barcelona, Spain
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31
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Maguire A, Brogi E. Sentinel lymph nodes for breast carcinoma: an update on current practice. Histopathology 2016; 68:152-67. [PMID: 26768036 PMCID: PMC5027880 DOI: 10.1111/his.12853] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/26/2015] [Indexed: 12/12/2022]
Abstract
Sentinel lymph node (SLN) biopsy has been established as the standard of care for axillary staging in patients with invasive breast carcinoma and clinically negative lymph nodes (cN0). Historically, all patients with a positive SLN underwent axillary lymph node dissection (ALND). The ACOSOG Z0011 trial showed that women with T1-T2 disease and cN0 who undergo breast-conserving surgery and whole-breast radiotherapy can safely avoid ALND. The main goal of SLN examination should be to detect all macrometastases (>2 mm). Gross sectioning of SLNs at 2-mm intervals and microscopic examination of one haematoxylin and eosin-stained section from each SLN block is the preferred method for pathological evaluation of SLNs. The role and timing of SLN biopsy for patients who have received neoadjuvant chemotherapy is controversial, and continues to be explored in clinical trials. SLN biopsies from patients with invasive breast carcinoma who have received neoadjuvant chemotherapy pose particular challenges for pathologists.
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Affiliation(s)
- Aoife Maguire
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Li Y, Xia Y, Li J, Wu D, Wan X, Wang K, Wu M, Liu J, Lau WY, Shen F. Prognostic Nomograms for Pre- and Postoperative Predictions of Long-Term Survival for Patients Who Underwent Liver Resection for Huge Hepatocellular Carcinoma. J Am Coll Surg 2015; 221:962-974.e4. [PMID: 26382973 DOI: 10.1016/j.jamcollsurg.2015.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 08/01/2015] [Accepted: 08/03/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver resection is an effective treatment in select patients with huge hepatocellular carcinoma (HCC, diameter ≥10 cm). This study aimed to develop nomograms for pre- and postoperative predictions of overall survival (OS) for these patients. STUDY DESIGN There were 464 consecutive patients who underwent liver resection for huge HCC at the Eastern Hepatobiliary Surgery Hospital (EHBH) between January 2008 and December 2009. They were collected and divided into a training cohort (n = 310) and an internal validation cohort (n = 154). Another 90 patients who were operated on at the Fujian Medical University (FMU) between January 2008 and April 2010 served as an external validation cohort. The surgical morbidity, mortality, time to recurrence, and OS were observed. Two prognostic nomograms were developed based separately on the data obtained before and after surgery. Discrimination and predictive accuracy of the models were measured using concordance index (C-index), calibration curves, and validation study. RESULTS The postoperative 4-year tumor recurrence and OS rates were, respectively, 79.0% and 41.2% in the patients from the EHBH and 78.8% and 37.6% in those from the FMU. Independent predictors of OS on multivariable analysis using pre- and postoperative data were respectively incorporated into the 2 nomograms. In the training cohort, calibration curves for the probability of 4-year postoperative survival fitted well. The C-indexes of the pre- and postoperative nomograms in predicting OS were 0.75 (95% CI 0.72 to 0.78) and 0.78 (95% CI 0.75 to 0.81), respectively. The internal and external validation studies optimally supported these results. CONCLUSIONS The 2 nomograms achieved accurate pre- or postoperative predictions of long-term survival for patients with huge HCC after liver resection.
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Affiliation(s)
- Yuntong Li
- Department of Hepatobiliary Surgery, the Mengchao Hepatobiliary Surgery Hospital, Fujian Medical University, Fuzhou, China; Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Yong Xia
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jun Li
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Dong Wu
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Xuying Wan
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Kui Wang
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Mengchao Wu
- Department of Hepatobiliary Surgery, the Mengchao Hepatobiliary Surgery Hospital, Fujian Medical University, Fuzhou, China; Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jingfeng Liu
- Department of Hepatobiliary Surgery, the Mengchao Hepatobiliary Surgery Hospital, Fujian Medical University, Fuzhou, China
| | - Wan Yee Lau
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Feng Shen
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
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Toshikawa C, Koyama Y, Nagahashi M, Tatsuda K, Moro K, Tsuchida J, Hasegawa M, Niwano T, Manba N, Ikarashi M, Kameyama H, Kobayashi T, Kosugi SI, Wakai T. Predictive Factors for Non-Sentinel Lymph Node Metastasis in the Case of Positive Sentinel Lymph Node Metastasis in Two or Fewer Nodes in Breast Cancer. J Clin Med Res 2015; 7:620-6. [PMID: 26124908 PMCID: PMC4471749 DOI: 10.14740/jocmr2195w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2015] [Indexed: 12/15/2022] Open
Abstract
Background In breast cancer, recent clinical trials have shown that sentinel lymph node biopsy (SLNB) alone without axillary lymph node dissection results in excellent prognosis if there is sentinel lymph node (SLN) metastasis in two or fewer nodes. The aim of the present study was to investigate the association between non-SLN metastasis and clinicopathological factors in case of SLN metastasis in two or fewer nodes in breast cancer. Methods Patients who underwent SLNB for invasive breast cancer and were found to have positive SLN in two or fewer nodes were evaluated. The associations between non-SLN metastasis and clinicopahological factors were examined. Statistical analyses were performed using the Mann-Whitney and Chi-square tests, with statistical significance set at P < 0.05. Results A total of 358 patients were enrolled during the study period and all of these patients were female and 54 patients had SLN metastasis (15%). Positive SLN in two or fewer nodes was identified in 44 patients (81.5%). Among these patients, 17 (38.6%) were found to have non-SLN metastasis. Non-SLN metastasis was associated with invasive tumor size (P = 0.015) and lymphatic involvement (P = 0.035). Multivariate analysis showed that tumor size (P = 0.011) and lymphatic involvement (P = 0.019) remained significant independent predictors of non-SLN metastasis, and that an invasive tumor size cut-off point of 28 mm was useful for dividing patients with positive SLN in two or fewer nodes into non-SLN-positive and non-SLN-negative groups. Conclusions Non-SLN metastasis was found in more than 30% of patients with SLN metastasis present in two or fewer nodes. Large tumor size and the presence of lymphatic involvement were significantly associated with non-SLN metastasis.
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Affiliation(s)
- Chie Toshikawa
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan
| | - Yu Koyama
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan ; Department of Nursing, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi, Niigata, Niigata 951-8518, Japan
| | - Masayuki Nagahashi
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan
| | - Kumiko Tatsuda
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan
| | - Kazuki Moro
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan
| | - Junko Tsuchida
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan
| | - Miki Hasegawa
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan
| | - Toshiyuki Niwano
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan
| | - Naoko Manba
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan
| | - Mayuko Ikarashi
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan
| | - Hitoshi Kameyama
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan
| | - Takashi Kobayashi
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan
| | - Shin-Ichi Kosugi
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan ; Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minami-Uonuma, Niigata 949-7302, Japan
| | - Toshifumi Wakai
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan
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Milner TD, de Lusignan S, Jones S, Jackson PA, Layer GT, Kissin MW, Irvine TE. Breast cancer metastasis burden in sentinel nodes analysed using one-step nucleic acid amplification predicts axillary nodal status. Breast 2015; 24:568-75. [PMID: 26032111 DOI: 10.1016/j.breast.2015.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 03/03/2015] [Accepted: 05/09/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In breast cancer patients undergoing sentinel lymph node biopsy (SLNB) analysis using one-step nucleic acid amplification (OSNA), clarity is required as to the risk factors for non-sentinel lymph node (NSLN) involvement upon axillary lymph node dissection (ALND). This study aims to identify these factors, including categorising by extent of sentinel node positivity: solitary positive node (solitary), multiple nodes with some positive (multiple incomplete positive), or multiple nodes all of which are positive (multiple all positive). METHODS We conducted a cohort study using prospectively collected data on 856 SLNBs analysed using OSNA, from patients with cT1-3 clinically node-negative invasive breast cancer. ALND was performed for 289 positive SLNBs. RESULTS NSLN metastases were identified in 73 (25.3%) ALNDs. Significant factors for NSLN involvement on multivariate analysis were: SLNB macrometastases (cytokeratin-19 mRNA count >5000 copies/μl) (adj.OR = 3.01; 95% CI, 1.61-5.66; p = 0.0006), multiple all positive vs. multiple incomplete positive SLNB (adj.OR = 2.92; 95% CI, 1.38-6.19; p = 0.0050), and undergoing mastectomy (adj.OR = 1.89; 95% CI, 1.00-3.55; p = 0.0486). Amongst multiple incomplete positive SLNBs, an 8.8% NSLN risk was identified when only micrometastases were present. CONCLUSION Extent of sentinel lymph node positivity measured using OSNA predicts NSLN metastasis risk, aiding decisions surrounding axillary treatment.
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Affiliation(s)
- Thomas D Milner
- The Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7XX, United Kingdom; University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom.
| | | | - Simon Jones
- University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom
| | - Peter A Jackson
- The Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7XX, United Kingdom
| | - Graham T Layer
- The Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7XX, United Kingdom; University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom
| | - Mark W Kissin
- The Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7XX, United Kingdom
| | - Tracey E Irvine
- The Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7XX, United Kingdom
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Raia-Barjat T, Trombert B, Khaddage A, Douchet C, Seffert P, Peoc'h M, Falk AT, Magné N, Chauleur C. OSNA (one-step nucleic acid amplification) sentinel lymph node intraoperative molecular analysis in breast cancer: a cost-benefit analysis. Med Oncol 2014; 31:322. [PMID: 25416045 DOI: 10.1007/s12032-014-0322-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/03/2014] [Indexed: 12/20/2022]
Abstract
The aim of the study was to analyze the medical and economic interest of OSNA molecular technique, compared to conventional postoperative histopathologic evaluation for sentinel lymph node exploration in breast cancer patients. This retrospective cost-benefit study was conducted in the French Universitary Hospital of Saint Etienne on patients who received sentinel lymph node exploration between July 1, 2007 and December 31, 2009. Lymph nodes were analyzed by conventional postoperative histological evaluation in group 1 (82 patients) and OSNA in group 2 (86 patients). Costs were analyzed in three different ways: surgery cost, hospitalization cost and histopathologic cost. Average operating time was slightly shorter for group 1 (histology) [71.9 vs. 76.8 min for group 2 (OSNA)]. Time and operating costs were not significantly different (p = 0.293). The average cost of pathological examination was significantly higher in group 2 (35.04 euros per node in group 1 vs. 291.84 euros per node in group 2 p < 10(-3)). The average length of hospital stay was significantly longer in group 1 (5.4 days in group 1 vs. 4.2 days in group 2, p = 0.0065). The total costs were not significantly different between both groups (3,774.6 euros in group 1 vs. 3,393.9 euros in group 2 p = 0.055). The sentinel lymph node analysis with OSNA technique does not lead to higher expenses. It also avoids another surgery for 20% of patients. A prospective multicentric medico-economic study made with a larger effective would probably confirm these results.
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Affiliation(s)
- Tiphaine Raia-Barjat
- Department of Gynecological and Oncological Surgery, University Medical Center, Saint Etienne, France
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