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Alonso-Espías M, Gracia M, Zapardiel I. Benefits of sentinel node detection in cervical cancer. Curr Opin Oncol 2024; 36:397-405. [PMID: 39007197 DOI: 10.1097/cco.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
PURPOSE OF REVIEW Sentinel lymph node biopsy (SLNB) is a widely used technique in other gynaecological tumours but has not yet been implemented as the gold standard technique for nodal staging in cervical cancer. Since the majority of evidence is derived from retrospective studies, this review aims to summarize the most recent evidence on this relevant topic. RECENT FINDINGS SLNB has demonstrated to be a well tolerated technique for lymph node staging in early-stage cervical cancer patients with promising future as exclusive lymph node assessment method avoiding full lymphadenectomy. Moreover, it allows ultrastaging and unfrequent drainage identification, which enables the detection of patients at a high risk of recurrence who would otherwise remain unnoticed. When compared with pelvic lymphadenectomy, SLNB is also associated with less intraoperative and postoperative complications, especially in terms of lymphedema formation. SUMMARY The available evidence suggests that SLNB offers numerous advantages over the standard pelvic lymphadenectomy reducing morbidity rates and increasing diagnostic accuracy. Three ongoing prospective trials will likely answer the controversies over these questions.
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Viveros-Carreño D, Mora-Soto N, Pareja R. Value of sentinel node ultrastaging and pathologic techniques in tumoral detection. Curr Opin Oncol 2024; 36:376-382. [PMID: 39007330 DOI: 10.1097/cco.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
PURPOSE OF REVIEW Sentinel lymph node assessment is an option for patients with clinically early-stage vulvar cancer, endometrial cancer, cervical cancer, and, more recently, ovarian cancer. However, although ultrastaging is mandatory as part of the node evaluation, universally accepted pathology protocols are lacking. This review focuses on the current evidence for the most relevant aspects of sentinel lymph node evaluation, as well as some controversial topics like frozen section or one-step nucleic acid amplification. RECENT FINDINGS The diagnostic accuracy of sentinel lymph node detection algorithms for patients with gynecologic neoplasms is high. However, the heterogeneity among the published studies and the absence of clear recommendations from most guidelines make it challenging to recommend one protocol over another. The minimum requirement from ultrastaging protocols (regarding the number of levels to be assessed, among others) to get the highest accuracy with a minor cost is unknown. SUMMARY Sentinel lymph node evaluation is now part of the surgical management for most early-stage gynecologic neoplasms. However, a universally accepted ultrastaging pathology protocol is lacking in literature and clinical practice. This gap requires significant effort from the gynecologic oncology and pathology community to be closed and then to allow advancements in surgical management for early-stage gynecologic tumors to go forward.
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Affiliation(s)
- David Viveros-Carreño
- Unidad Ginecología Oncológica, Grupo de Investigación GIGA, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo - CTIC
- Department of Gynecologic Oncology, Clínica Universitaria Colombia
| | - Nathalia Mora-Soto
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología
- Universidad Militar Nueva Granada, Bogotá
| | - René Pareja
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología
- Gynecologic Oncology, Clínica ASTORGA, Medellín, Colombia
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Li K, Meng M, Zhang W, Li J, Wang Y, Zhou C. Diagnostic value of one-step nucleic acid amplification for sentinel lymph node metastasis in cytokeratin 19-positive tumors: evidence from bioinformatics and meta-analysis. Front Oncol 2024; 14:1370709. [PMID: 38651158 PMCID: PMC11033366 DOI: 10.3389/fonc.2024.1370709] [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: 01/16/2024] [Accepted: 03/19/2024] [Indexed: 04/25/2024] Open
Abstract
Background The status of the sentinel lymph nodes (SLNs) was an important prognostic factor in varies cancers. A one-step nucleic acid amplification (OSNA) assay, a molecular-based whole-node analysis method based on CK19 mRNA copy number, was developed to diagnose lymph node metastases. We aimed to evaluate the value of OSNA for the diagnosis of sentinel lymph node metastasis in CK19 positive cancers. CK19 mRNA and protein expression for pan-caner analysis were obtained from TCGA and the Human protein atlas database. Methods Two researchers independently searched the PubMed, Cochrane Library and Web of Science databases for qualified articles published before December 1, 2023. A meta-analysis was performed using MetaDisc and STATA. Risk bias and quality assessments of the included studies were evaluated, and a subgroup analysis was performed. Ten cancer types were found to be CK19 positively expressed and 7 of 10 had been reported to use OSNA for SLN detection. Results After literature review, there were 61 articles included in the meta-analysis, which consisted of 7115 patients with 18007 sentinel lymph nodes. The pooled sensitivity and specificity of OSNA were 0.87 and 0.95 in overall patients. Moreover, we found the background CK19 expression in normal tissue affected the diagnostic accuracy of OSNA. In breast cancer, we performed subgroup analysis. OSNA exhibited to be a stable method across different population groups and various medical centers. In addition, when 250 copies/μl was chosen as the cutoff point of CK19 mRNA, there were a relatively higher sensitivity and AUC in detecting SLN micro-metastasis than 5000 copies/μl. Discussion OSNA can predict the occurrence of SLN metastasis accurately in CK19 positive cancers, especially in breast cancer, colorectal cancer, lung cancer, gastric cancer and endometrial cancer. Our study warrants future studies investigating the clinical application of OSNA in pancreatic, ovarian and bladder cancers.
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Affiliation(s)
- Ke Li
- Department of Central Laboratory, Liaocheng People’s Hospital, Liaocheng, Shandong, China
| | - Min Meng
- Department of Central Laboratory, Liaocheng People’s Hospital, Liaocheng, Shandong, China
| | - Weiwei Zhang
- Department of Central Laboratory, Liaocheng People’s Hospital, Liaocheng, Shandong, China
| | - Junyi Li
- Department of Clinical Medicine, Shandong First Medical University, Jinan, Shandong, China
| | - Yiting Wang
- Department of Central Laboratory, Liaocheng People’s Hospital, Liaocheng, Shandong, China
| | - Changhui Zhou
- Department of Central Laboratory, Liaocheng People’s Hospital, Liaocheng, Shandong, China
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Bizzarri N, Fedele C, Teodorico E, Certelli C, Pedone Anchora L, Carbone V, Giannarelli D, Fagotti A, Zannoni GF, Valente M, Querleu D, Ferrandina G, Scambia G, Fanfani F. Survival associated with the use of one-step nucleic acid amplification (OSNA) to detect sentinel lymph node metastasis in cervical cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108250. [PMID: 38461568 DOI: 10.1016/j.ejso.2024.108250] [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: 02/01/2024] [Revised: 02/22/2024] [Accepted: 03/03/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Sentinel lymph node (SLN) biopsy is part of surgical treatment of apparent early-stage cervical cancer. SLN is routinely analyzed by ultrastaging and immunohistochemistry. The aim of this study was to assess the survival of patients undergoing SLN analyzed by one-step nucleic acid amplification (OSNA) compared with ultrastaging. METHODS Single-center, retrospective, cohort study. Patients undergoing primary surgery and SLN mapping ( ±pelvic lymphadenectomy) for apparent early-stage cervical cancer between May 2017 and January 2021 were included. SLN was analyzed exclusively with OSNA or with ultrastaging. Patients with bilateral SLN mapping failure, with SLN analyzed alternatively/serially with OSNA and ultrastaging, and undergoing neo-adjuvant therapy were excluded. Baseline clinic-pathological differences between the two groups were balanced with propensity-match analysis. RESULTS One-hundred and fifty-seven patients were included, 50 (31.8%) in the OSNA group and 107 (68.2%) in the ultrastaging group. Median follow up time was 41 months (95%CI:37.9-42.2). 5-year DFS in patients undergoing OSNA versus ultrastaging was 87.0% versus 91.0% (p = 0.809) and 5-year overall survival was 97.9% versus 98.6% (p = 0.631), respectively. No difference in the incidence of lymph node recurrence between the two groups was noted (OSNA 20.0% versus ultrastaging 18.2%, p = 0.931). In the group of negative SLN, no 5-year DFS difference was noted between the two groups (p = 0.692). No 5-year DFS and OS difference was noted after propensity-match analysis (87.6% versus 87.0%, p = 0.726 and 97.4% versus 97.9%, p = 0.998, respectively). CONCLUSION The use of OSNA as method to exclusively process SLN in cervical cancer was not associated with worse DFS compared to ultrastaging. Incidence of lymph node recurrence in the two groups was not different.
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Affiliation(s)
- Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Camilla Fedele
- UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Elena Teodorico
- UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Camilla Certelli
- UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luigi Pedone Anchora
- UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Vittoria Carbone
- UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Diana Giannarelli
- Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Gian Franco Zannoni
- Gynecopathology and Breast Pathology Unit, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Michele Valente
- Gynecopathology and Breast Pathology Unit, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Denis Querleu
- UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica Del Sacro Cuore, Rome, Italy
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Togami S, Tanimoto A, Yanazume S, Tokunaga H, Nagai T, Watanabe M, Yahata H, Asanoma K, Yamamoto H, Tanaka T, Ohmichi M, Yamada T, Todo Y, Yamada R, Kato H, Yamagami W, Masuda K, Kawaida M, Niikura H, Moriya T, Kobayashi H. Evaluation of the one-step nucleic acid amplification assay for detecting lymph node metastasis in patients with cervical and endometrial cancer: A multicenter prospective study. Gynecol Oncol 2023; 170:70-76. [PMID: 36638744 DOI: 10.1016/j.ygyno.2022.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This multicenter study aimed to evaluate the accuracy of the one-step nucleic acid amplification (OSNA) assay in diagnosing lymph node metastasis (LNM) in patients with cervical and endometrial cancers. METHODS Surgically removed LNs from patients with cervical and endometrial cancer were sectioned at 2-mm intervals along the short axis direction and alternately examined using the OSNA assay and conventional histopathological examination. Ultrastaging (200-μm LN sections) was performed for metastatic LNs using hematoxylin and eosin staining and immunostaining with an anti-CK19 antibody in cases where the OSNA assay and histopathological examination (performed using 2-mm LN sections) results showed discordance. RESULTS A total of 437 LNs from 133 patients were included; 61 patients (14%) showed metastasis by histopathological examination, with a concordance rate of 0.979 (95% confidence interval [CI]: 0.961-0.991) with the OSNA assay. The sensitivity and specificity of the OSNA assay were 0.918 (95% CI: 0.819-0.973) and 0.989 (95% CI: 0.973-0.997), respectively. Discordance between the two methods was observed in nine LNs (2.1%), and allocation bias of metastatic foci was identified as the major cause of discordance. CONCLUSIONS The OSNA assay showed equally accurate detection of LN metastasis as the histopathological examination. We suggest that the OSNA assay may be a useful tool for the rapid intraoperative diagnosis of LN metastasis in patients with cervical and endometrial cancers.
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Affiliation(s)
- Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Akihide Tanimoto
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shintaro Yanazume
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Hideki Tokunaga
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Miyagi, Japan
| | - Tomoyuki Nagai
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Miyagi, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku Kosai Hospital, Sendai, Japan
| | - Hideaki Yahata
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuo Asanoma
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohito Tanaka
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Takashi Yamada
- Department of Pathology, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Yukiharu Todo
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo 003-0804, Japan
| | - Ryutaro Yamada
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo 003-0804, Japan
| | - Hidenori Kato
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo 003-0804, Japan
| | - Wataru Yamagami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kenta Masuda
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Miho Kawaida
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hitoshi Niikura
- Department of Obstetrics and Gynecology, National Hospital Organization Sendai Medical Center, Miyagi, Japan
| | - Takuya Moriya
- Department of Pathology, Kawasaki Medical School, Okayama, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
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Application of One-Step Nucleic Acid Amplification (OSNA) in different cancer entities and usefulness in prostate cancer: a systematic review. BMC Cancer 2022; 22:357. [PMID: 35366849 PMCID: PMC8976947 DOI: 10.1186/s12885-022-09355-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background Lymph node (LN) status is a key prognostic factor in the decision-making process of different cancer entities, including prostate cancer (PCa). Sectioning and haematoxylin and eosin (H&E) staining technique remain the gold standard for the evaluation of LN metastases despite some limitations, especially low sensitivity in detecting an accurate tumour burden within the LN, as well as a subjective and time-consuming result. One-step nucleic acid amplification (OSNA) quantifies mRNA copies of cytokeratin 19 (CK19) in a fast, objective, automated, and reproducible way, raising a general interest to explore its utility for lymphatic metastasis identification in different malignancies. Methods To present the latest evidence related to the detection of LN metastases in several tumours by using OSNA compared with the conventional H&E method, a systematic review of articles published since March 2021 was conducted using PubMed, Cochrane Library, and Web of Science databases. References from primary papers and review articles were checked to obtain further potential studies. Our procedure for evaluating records identified during the literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. With the aim to design and justify future clinical routine use of OSNA in PCa, novel PCa evidence has been included in this review for the first time. Results Twenty five studies were included. LN from six different groups of tumours: breast, gastrointestinal, gynecological, lung, head and neck and prostate cancers has been assessed. OSNA was compared with post-operative formalin-fixed paraffin-embedded tissue sections with H&E staining as the reference standard. Contingency tables were created, and concordance rate, sensitivity, specificity and predictive values were reported. Seventeen studies analysed the discordant cases using different techniques. Conclusion OSNA method has a high diagnostic accuracy for the detection of LN metastases in several CK19 expressing tumours. Available evidence might encourage future investigations about its usage in PCa patients to improve LN staging and prognosis.
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Clinical Study of Sentinel Lymph Node Detection to Evaluate Pelvic Lymph Node Metastasis to Determine the Prognosis of Patients with Early Cervical Cancer. Appl Bionics Biomech 2022; 2022:8394049. [PMID: 35369006 PMCID: PMC8967555 DOI: 10.1155/2022/8394049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 01/05/2023] Open
Abstract
Objective Lymph node status is one of the most important prognostic factors for uterine cervical cancer. Sentinel lymph node (SLN) biopsy has emerged as a potential alternative to systematic lymphadenectomy for the lymph node mapping in such patients. However, the SLN metastasis detection via SLN biopsy in early-stage cervical cancer remains controversial. The current study is aimed at investigating the feasibility and accuracy of combined tracer method for localization of SLN in initial stages of cervical cancer and to evaluate the clinical value of SLN biopsy in replacing pelvic lymph node resection. Methods We retrospectively reviewed 348 cases who were admitted to the Department of Gynecologic Oncology, Shandong Provincial Cancer Hospital, China, between February 2003 and June 2018 with FIGO stage IA2 to IIA2 cervical cancer and undergone through SLN biopsy. Methylthioninium chloride was injected in combination with 99mtechnetium-labeled sulfur colloid prior to surgery to these patients. SLNs were identified intraoperatively, excised, and subsequently submitted to fast frozen section. The detection rates, accuracy, sensitivity, coincidence rate, false negative rate, and negative predictive values of these cases were estimated, and the follow-up outcomes were carefully observed. Chi squared test or Fisher's exact test was employed for a comparison of the categorical variables. Univariate and multivariate Cox proportional hazard models were used for estimation of relationships between overall survival (OS) and disease-free survival (DFS) and prognostic factors. Results The total detection rate of SLN was 97.1% (338/348), and identification of bilateral SLN was successful in 237 patients (70.1%). The patient's tumor size, FIGO stage, lymph node metastasis, and depth of invasion had statistically significant differences in SLN detection rates. The detection rate had inverse relation with tumors size (>4 cm), invasive depth > 2/3, lymph node positive, late staging, and preoperative radiotherapy. 117 positive SLNs were detected in 73 patients. The negative predictive value, sensitivity, false negative rate, and coincidence rate and were 97.7%, 92.4%, 7.6%, and 95.4%, respectively. In patients whose tumor size were ≦ 4 cm, the false negative rate was 4.55% (2/44), whereas it was 0 in patients with tumor size≦2 cm. The respective 1, 3, and 5-year OS was 100%, 94.8%, and 91.8%, respectively, whereas DFS rate for 1, 3, and 5 years was 96.7%, 92%, and 89.6%, respectively. The lymph node was positive, tumor size, the depth of invasion, and staging were statistically different from the recurrence rate and survival rate of patients (p < 0.05). When tumor metastasis exceeded SLN, the recurrence rate was significantly increased, and survival rate is significantly reduced (p < 0.05, p < 0.01, p < 0.05, respectively). Conclusions The identification of SLN combined with 99mtechnetium-labeled sulfur colloid and methylthioninium chloride has a good accuracy and is safe for the assessment of the status of pelvic nodes in patients with initial stage cervical cancer. Nuclide as a tracer has low dependence on objective conditions and doctors' technology and has a good detection rate. In our study, we believe that SLN biopsy is feasible when the tumor is ≦ 4 cm. Large scale clinical trials are required in China expand the sample size and validate the results of this study.
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Togami S, Ushiwaka T, Kitazono I, Yanazume S, Kamio M, Tanimoto A, Kobayashi H. One-step nucleic acid amplification (OSNA) assay for detecting lymph node metastasis in cervical and endometrial cancer: a preliminary study. J Gynecol Oncol 2021; 33:e11. [PMID: 34910392 PMCID: PMC8899876 DOI: 10.3802/jgo.2022.33.e11] [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: 05/13/2021] [Revised: 09/22/2021] [Accepted: 10/28/2021] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the accuracy of the one-step nucleic acid amplification (OSNA) assay for the diagnosis of lymph node (LN) metastasis in uterine cancer. Methods A total of 116 LNs from 30 patients with cervical and endometrial cancer, enrolled in this prospective study, were used. Excised LNs were cut into 4 to 6 blocks at 2 mm intervals, and nonadjacent blocks were alternately subjected to either histological examination or the OSNA assay. Results The concordance rate between histological examination and the OSNA assay in cervical cancer and in endometrial cancer was 95.9% and 95.2%, respectively. The sensitivity, specificity, and negative predictive value of the OSNA assay were 80%, 97.7%, and 97.7% in cervical cancer, and 85.7%, 93.3%, and 98.2% in endometrial cancer, respectively. In cervical cancer, discordant results were observed in 2 out of 49 LNs (4.1%); 1 was OSNA assay-positive and histological examination-negative, and 1 was OSNA assay-negative and histological examination-positive. In endometrial cancer, discordant results were observed in 5 out of 67 LNs (7.5%); 4 were OSNA assay-positive and histological examination-negative, and 1 was OSNA assay-negative and histological examination-positive. Conclusion The OSNA assay showed high concordance rate with histological examination, sensitivity, and specificity in uterine cancer, suggesting that it could enhance the accuracy of conventional pathological examination for the detection of LN metastasis by reducing false negative rate. High concordance rate between the one-step nucleic acid amplification (OSNA) assay and histological examination in uterine cancer. OSNA assay demonstrates high sensitivity and specificity for metastatic lymph node detection. Preoperative confirmation of cytokeratin 19 expression in primary tumors may reduce false-negative results.
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Affiliation(s)
- Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Takashi Ushiwaka
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Ikumi Kitazono
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shintaro Yanazume
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Masaki Kamio
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Akihide Tanimoto
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
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Diestro MD, Berjón A, Zapardiel I, Yébenes L, Ruiz I, Lekuona A, Rezola M, Jaunarena I, Siegrist J, Sánchez-Pastor M, Cuadra M, Sagasta A, Guerra I, Lete LI, Roldán F, Marta CB, Boillos MJ, Cardiel MJ, López-de la Manzanara C, Relea F, Coronado PJ, Pascual A, Román MJ, Peiró G, Matute LJ, Montero B, Muruzábal JC, Guarch R, Zorrero C, Calatrava A, Ribot L, Costa I, Hernández A, Hardisson D. One-Step Nucleic Acid Amplification (OSNA) of Sentinel Lymph Node in Early-Stage Endometrial Cancer: Spanish Multicenter Study (ENDO-OSNA). Cancers (Basel) 2021; 13:4465. [PMID: 34503275 PMCID: PMC8431061 DOI: 10.3390/cancers13174465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/24/2022] Open
Abstract
The objective of this study was to evaluate the efficacy of one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node (SLN) metastasis compared to standard pathological ultrastaging in patients with early-stage endometrial cancer (EC). A total of 526 SLNs from 191 patients with EC were included in the study, and 379 SLNs (147 patients) were evaluated by both methods, OSNA and standard pathological ultrastaging. The central 1 mm portion of each lymph node was subjected to semi-serial sectioning at 200 μm intervals and examined by hematoxylin-eosin and immunohistochemistry with CK19; the remaining tissue was analyzed by OSNA for CK19 mRNA. The OSNA assay detected metastases in 19.7% of patients (14.9% micrometastasis and 4.8% macrometastasis), whereas pathological ultrastaging detected metastasis in 8.8% of patients (3.4% micrometastasis and 5.4% macrometastasis). Using the established cut-off value for detecting SLN metastasis by OSNA in EC (250 copies/μL), the sensitivity of the OSNA assay was 92%, specificity was 82%, diagnostic accuracy was 83%, and the negative predictive value was 99%. Discordant results between both methods were recorded in 20 patients (13.6%). OSNA resulted in an upstaging in 12 patients (8.2%). OSNA could aid in the identification of patients requiring adjuvant treatment at the time of diagnosis.
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Affiliation(s)
- María Dolores Diestro
- Gynecologic Oncology Unit, Department of Gynecology and Obstetrics, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research (IdiPAZ), Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (I.Z.); (J.S.); (M.S.-P.); (A.H.)
| | - Alberto Berjón
- Department of Pathology, Hospital Universitario La Paz, Molecular Pathology and Therapeutic Targets Group, Hospital La Paz Institute for Health Research (IdiPAZ), Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (A.B.); (L.Y.)
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, Department of Gynecology and Obstetrics, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research (IdiPAZ), Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (I.Z.); (J.S.); (M.S.-P.); (A.H.)
| | - Laura Yébenes
- Department of Pathology, Hospital Universitario La Paz, Molecular Pathology and Therapeutic Targets Group, Hospital La Paz Institute for Health Research (IdiPAZ), Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (A.B.); (L.Y.)
| | - Irune Ruiz
- Department of Pathology, Hospital Universitario Donostia Osakidetza, 20014 Donostia, Spain; (I.R.); (M.R.)
| | - Arantza Lekuona
- Department of Gynecology, Hospital Universitario Donostia Osakidetza, 20014 Donostia, Spain; (A.L.); (I.J.)
| | - Marta Rezola
- Department of Pathology, Hospital Universitario Donostia Osakidetza, 20014 Donostia, Spain; (I.R.); (M.R.)
| | - Ibon Jaunarena
- Department of Gynecology, Hospital Universitario Donostia Osakidetza, 20014 Donostia, Spain; (A.L.); (I.J.)
| | - Jaime Siegrist
- Gynecologic Oncology Unit, Department of Gynecology and Obstetrics, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research (IdiPAZ), Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (I.Z.); (J.S.); (M.S.-P.); (A.H.)
| | - Margarita Sánchez-Pastor
- Gynecologic Oncology Unit, Department of Gynecology and Obstetrics, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research (IdiPAZ), Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (I.Z.); (J.S.); (M.S.-P.); (A.H.)
| | - María Cuadra
- Department of Gynecology, Instituto de Investigación Bioaraba, OSI Araba Hospital Universitario, 01009 Vitoria-Gasteiz, Spain; (M.C.); (L.I.L.)
| | - Amaia Sagasta
- Department of Pathology, Instituto de Investigación Bioaraba, OSI Araba Hospital Universitario, 01009 Vitoria-Gasteiz, Spain; (A.S.); (I.G.)
| | - Isabel Guerra
- Department of Pathology, Instituto de Investigación Bioaraba, OSI Araba Hospital Universitario, 01009 Vitoria-Gasteiz, Spain; (A.S.); (I.G.)
| | - Luis I. Lete
- Department of Gynecology, Instituto de Investigación Bioaraba, OSI Araba Hospital Universitario, 01009 Vitoria-Gasteiz, Spain; (M.C.); (L.I.L.)
| | - Fernando Roldán
- Department of Gynecology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (F.R.); (M.J.B.)
| | - Carlo B. Marta
- Department of Pathology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (C.B.M.); (M.J.C.)
| | - María J. Boillos
- Department of Gynecology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (F.R.); (M.J.B.)
| | - María J. Cardiel
- Department of Pathology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (C.B.M.); (M.J.C.)
| | - Carlos López-de la Manzanara
- Department of Gynecology, Hospital General Universitario Ciudad Real, Universidad de Castilla-La Mancha, 13005 Ciudad Real, Spain;
| | - Fernanda Relea
- Department of Pathology, Hospital General Universitario Ciudad Real, Universidad de Castilla-La Mancha, 13005 Ciudad Real, Spain;
| | - Pluvio J. Coronado
- Women Health Institute, Hospital Clínico Universitario San Carlos, IdISSC, Complutense University, 28040 Madrid, Spain;
| | - Alejandro Pascual
- Department of Pathology, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain;
| | - María J. Román
- Department of Gynecology, Hospital General Universitario Alicante and Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain;
| | - Gloria Peiró
- Department of Pathology, Hospital General Universitario Alicante and Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain;
| | - Luis J. Matute
- Department of Gynecology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
| | - Beatriz Montero
- Department of Pathology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
| | - Juan C. Muruzábal
- Department of Gynecology, Complejo Hospitalario Universitario Navarra, 31008 Pamplona, Spain;
| | - Rosa Guarch
- Department of Pathology, Complejo Hospitalario Universitario Navarra, 31008 Pamplona, Spain;
| | - Cristina Zorrero
- Department of Gynecology, Hospital Fundación IVO, 46009 Valencia, Spain;
| | - Ana Calatrava
- Department of Pathology, Hospital Fundación IVO, 46009 Valencia, Spain;
| | - Laia Ribot
- Department of Gynecology, Corporación Sanitaria Parc Taulí Sabadell, 08208 Barcelona, Spain;
| | - Irmgard Costa
- Department of Pathology, Corporación Sanitaria Parc Taulí Sabadell, 08208 Barcelona, Spain;
| | - Alicia Hernández
- Gynecologic Oncology Unit, Department of Gynecology and Obstetrics, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research (IdiPAZ), Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (I.Z.); (J.S.); (M.S.-P.); (A.H.)
| | - David Hardisson
- Department of Pathology, Hospital Universitario La Paz, Molecular Pathology and Therapeutic Targets Group, Hospital La Paz Institute for Health Research (IdiPAZ), Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (A.B.); (L.Y.)
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10
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Yuan X, Yi M, Dong B, Chu Q, Wu K. Prognostic significance of KRT19 in Lung Squamous Cancer. J Cancer 2021; 12:1240-1248. [PMID: 33442422 PMCID: PMC7797641 DOI: 10.7150/jca.51179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
Backgroud: Keratin 19 (KRT19) is the intermediate filament that constitutes the cytoskeleton and regulates cell-cycle and cell death. Objective: We aimed to assess whether KRT19 was involved in lung cancer development. Methods: The expression of KRT19 in lung cancer was evaluated from mRNA expression on open databse and protein abundance on tumor tissue array. Results: Using open microarray gene expression datasets and differential expression analysis, we found that KRT19 was upregulated in lung cancer compared with normal tissue. Further analysis suggested that KRT19 mRNA expression was correlated with tumor progression and overall survival in lung cancer patients. As KRT19 was overexpressed in adenocarcinoma (AC) and squamous cell carcinoma (SCC), we examined the prognostic value of KRT19 protein abundance by tissue microarray (TMA). The results suggested that protein expression of KRT19 was significantly associated with overall survival of SCC. Conclusions: Giving the prognostic role of KRT19 in lung cancer, KRT19 could be considered as an potential molecular marker in lung cancer, especially in SCC.
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Affiliation(s)
- Xun Yuan
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, P.R. China
| | - Ming Yi
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, P.R. China
| | - Bing Dong
- Department of Molecular Pathology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, P.R. China
| | - Kongming Wu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, P.R. China.,Department of Molecular Pathology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China
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11
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The evolving role of one-step nucleic acid amplification (OSNA) for the intra-operative detection of lymph node metastases: A diagnostic accuracy meta-analysis. Eur J Surg Oncol 2020; 47:1233-1243. [PMID: 33309549 DOI: 10.1016/j.ejso.2020.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/21/2020] [Accepted: 12/01/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND One Step Nucleic Acid Amplification (OSNA) assay has recently emerged as a rapid molecular diagnostic tool for the detection of lymph node (LN) metastases. It is a molecular technique that analyses the entire LN tissue using a reverse-transcriptase loop-mediated isothermal amplification reaction to detect tumour specific cytoceratin 19 mRNA. AIM To ascertain the diagnostic accuracy of OSNA assay in detecting LN metastases amongst different types of malignancy. DESIGN We systematically searched MEDLINE, SCOPUS, ClinicalTrials.gov, and Cochrane Database, from inception up to August 2020. Quality assessment was performed using the Modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). We calculated pooled diagnostic indices using the random-effects model. Meta-regression and sub-group analyses were performed to address heterogeneity. RESULTS 31 studies were included in this meta-analysis, including four different types of cancer. The risk of bias and the overall quality of included studies was moderate to high. There was no evidence of publication bias. The pooled diagnostic odds ratio (DOR) for detecting LN metastases in gynaecological, head & neck/thyroid, gastrointestinal and lung cancer were 100.38, 76.17, 275.14, and 305.84, respectively. CONCLUSIONS Our findings suggest that OSNA assay had a high diagnostic accuracy in detecting metastatic LNs in different types of malignancy. This evidence is constrained by the limited studies available for few tumour types and the rather high heterogeneity for few outcomes.
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12
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Santoro A, Angelico G, Inzani F, Arciuolo D, Spadola S, Valente M, D'Alessandris N, Piermattei A, Fiorentino V, CIanfrini F, Bizzarri N, Pedone Anchora L, Fagotti A, Scambia G, Zannoni GF. Standard ultrastaging compared to one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node metastases in early stage cervical cancer. Int J Gynecol Cancer 2020; 30:1871-1877. [PMID: 33127865 DOI: 10.1136/ijgc-2020-001710] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE We compared ultrastaging and one-step nucleic acid amplification (OSNA) examination of sentinel lymph nodes in two homogeneous patient populations diagnosed with early stage cervical cancer. The primary aim of our study was to evaluate the rate and type of sentinel lymph node metastases detected by ultrastaging and OSNA assay. Secondary aims were to define the sensitivity and the negative predictive value of sentinel lymph node biopsy assessed with OSNA and ultrastaging and to define the role of sentinel lymph node assessment in predicting non-sentinel lymph node status. METHODS Consecutive patients who underwent surgery (radical hysterectomy or trachelectomy or cervical conization) at our institution, between January 2018 and March 2020, were enrolled. All patients had a preoperative diagnosis of early-stage cervical carcinoma (International Federation of Gynecology and Obstetrics (FIGO) 2018 stages IA-IIB) and underwent sentinel lymph node assessment with ultrastaging or OSNA. Patients with advanced FIGO stages and special histology subtypes (other than squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma) or patients with sentinel lymph nodes analyzed only with hematoxylin and eosin were excluded. Clinical data were compared using the χ2 test and Fisher's exact test. A κ coefficient was determined with respect to lymph node assessment. A p value <0.05 was considered statistically significant. RESULTS A total of 116 patients were included in this retrospective analysis (53 ultrastaging, 63 OSNA). Overall, 531 and 605 lymph nodes were removed in the ultrastaging and OSNA groups, respectively, and 140 and 129 sentinel lymph nodes were analyzed in the ultrastaging and OSNA groups, respectively. 22 patients had metastatic sentinel lymph nodes: 6 (11.3%) of 53 patients in the ultrastaging group and 16 (25.4%) of 63 patients in the OSNA group. The total amount of positive SLNs was 7 (5%) of 140 in the ultrastaging group and 21 (16.3%) of 129 in the OSNA group, respectively (p=0.0047). Pelvic lymphadenectomy was performed in 26 (49.1%) of 53 patients in the ultrastaging group and in 34 (54%) of 63 patients in the OSNA group due to comorbidities. Metastatic non-sentinel lymph nodes were found in 4 patients: 2 (7.7%) of 26 patients in the ultrastaging group and 2 (5.9%) of 34 patients in the OSNA group, respectively. The total amount of positive pelvic lymph nodes was 3 (0.6%) of 531 in the ultrastaging group and 4 (0.7%) of 605 in the OSNA group (p=0.61). In the OSNA group, only 2 patients with negative sentinel lymph nodes had metastatic disease in the pelvic lymph nodes. By contrast, no patients with OSNA-positive sentinel lymph nodes had metastases in the pelvic lymph nodes. In the ultrastaging group, all patients with negative sentinel lymph nodes did not have metastatic disease in other pelvic lymph nodes. CONCLUSIONS OSNA assessment of sentinel lymph nodes was associated with a negative predictive value of 91% but poor reliability in detecting node metastases in non-sentinel pelvic lymph nodes. Of note, the ultrastaging protocol revealed higher sensitivity and more reliability in predicting pelvic non-sentinel lymph node status.
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Affiliation(s)
- Angela Santoro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Angelico
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Frediano Inzani
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Damiano Arciuolo
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Saveria Spadola
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michele Valente
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicoletta D'Alessandris
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessia Piermattei
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Fiorentino
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica CIanfrini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicolò Bizzarri
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Pedone Anchora
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anna Fagotti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Franco Zannoni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy .,Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Peiris-Pagès M, Ozsvári B, Sotgia F, Lisanti MP. Mitochondrial and ribosomal biogenesis are new hallmarks of stemness, oncometabolism and biomass accumulation in cancer: Mito-stemness and ribo-stemness features. Aging (Albany NY) 2020; 11:4801-4835. [PMID: 31311889 PMCID: PMC6682537 DOI: 10.18632/aging.102054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/20/2019] [Indexed: 12/11/2022]
Abstract
Using proteomics analysis, we previously compared MCF7 breast cancer cells grown as 3D tumor spheres, with the same cell line grown as monolayers. Our results indicated that during 3D anchorage‐independent growth, the cellular machinery associated with i) mitochondrial biogenesis and ii) ribosomal biogenesis, were both significantly increased. Here, for simplicity, we refer to these two new oncogenic hallmarks as “mito‐stemness” and “ribo‐stemness” features. We have now applied this same type of strategy to begin to understand how fibroblasts and MCF7 breast cancer cells change their molecular phenotype, when they are co‐cultured together. We have previously shown that MCF7‐fibroblast co‐cultures are a valuable model of resistance to apoptosis induced by hormonal therapies, such as Tamoxifen and Fulvestrant. Here, we directly show that these mixed co‐cultures demonstrate the induction of mito‐stemness and ribo‐stemness features, likely reflecting a mechanism for cancer cells to increase their capacity for accumulating biomass. In accordance with the onset of a stem‐like phenotype, KRT19 (keratin 19) was induced by ~6‐fold during co‐culture. KRT19 is a well‐established epithelial CSC marker that is used clinically to identify metastatic breast cancer cells in sentinel lymph node biopsies. The potential molecular therapeutic targets that we identified by label‐free proteomics of MCF7‐fibroblast co‐cultures were then independently validated using a bioinformatics approach. More specifically, we employed publically‐available transcriptional profiling data derived from primary tumor samples from breast cancer patients, which were previously subjected to laser‐capture micro‐dissection, to physically separate breast cancer cells from adjacent tumor stroma. This allowed us to directly validate that the proteins up‐regulated in this co‐culture model were also transcriptionally elevated in patient‐derived breast cancer cells in vivo. This powerful approach for target identification and translational validation, including the use of patient outcome data, can now be applied to other tumor types as well, to validate new therapeutic targets that are more clinically relevant, for patient benefit. Moreover, we discuss the therapeutic implications of these findings for new drug development, drug repurposing and Tamoxifen‐resistance, to effectively target mito‐stemness and ribo‐stemness features in breast cancer patients. We also discuss the broad implications of this “organelle biogenesis” approach to cancer therapy.
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Affiliation(s)
- Maria Peiris-Pagès
- Clinical and Experimental Pharmacology, University of Manchester, Cancer Research UK, Manchester, United Kingdom
| | - Béla Ozsvári
- Translational Medicine, School of Environment and Life Sciences, Biomedical Research Centre (BRC), University of Salford, Greater Manchester, United Kingdom
| | - Federica Sotgia
- Translational Medicine, School of Environment and Life Sciences, Biomedical Research Centre (BRC), University of Salford, Greater Manchester, United Kingdom
| | - Michael P Lisanti
- Translational Medicine, School of Environment and Life Sciences, Biomedical Research Centre (BRC), University of Salford, Greater Manchester, United Kingdom
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14
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Diagnostic value of frozen section examination of sentinel lymph nodes in early-stage cervical cancer at the time of ultrastaging. Gynecol Oncol 2020; 158:576-583. [PMID: 32595022 DOI: 10.1016/j.ygyno.2020.05.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/26/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We aimed to assess the diagnostic value of frozen-section pathologic examination (FSE) of sentinel lymph nodes (SLN) in patients with early-stage cervical cancer. METHODS Two French prospective multicentric database on SLN biopsy for cervical cancer (SENTICOL I and II) were analysed. Patients with IA to IIA1 2018 FIGO stage, who underwent SLN biopsy with both FSE and ultrastaging examination were included. RESULTS AND DISCUSSION Between 2005 and 2012, 313 patients from 25 centers fulfilled the inclusion criteria. Metastatic involvement of SLN was diagnosed in 52 patients (16.6%). Macrometastases, micrometastases and isolated tumor cells (ITCs) were found in 27, 12 and 13 patients respectively. Among the 928 SLNs analysed, FSE identified 23 SLNs with macrometastases in 20 patients and 5 SLNs with micrometastases in 2 patients whereas no ITCs were identified. Ultrastaging of negative SLNs by FSE found macrometastases, micrometastases and ITCs in additional 7, 11 and 17 SLNs. Ultrastaging increased significantly the rate of patients with positive SLN from 7% to 16.6% (p < 0.0001). The sensitivity and the negative predictive value of FSE were 42.3% and 89.7% respectively or 56.4% and 94.1% if ITCs were excluded. False-negative cases were more frequent with tumor size ≥ 20 mm (OR = 4.46, 95%IC = [1.45-13.66], p = 0.01) and preoperative brachytherapy (OR = 4.47, 95%IC = [1.37-14.63], p = 0.01) and less frequent with patients included in higher volume center (>5 patients/year) (OR = 0.09, 95%IC = [0.02-0.51], p = 0.01). CONCLUSIONS FSE of SLN had a low sensitivity for detecting micrometastases and ITCs and a high negative predictive value for SLN status. Clinical impact of false-negative cases has to be assessed by further studies.
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15
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Tu H, Gu HF, Huang H, Liu KJ, Yun JP, Chen JP, Zhang XK, Yahata H, Sonoda K, Zhang HY, Liu JH. Sectioning protocol determines accuracy of intraoperative pathological examination of sentinel lymph node in cervical cancer: A systematic review and meta-analysis. Gynecol Oncol 2020; 158:489-497. [PMID: 32507651 DOI: 10.1016/j.ygyno.2020.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To determine the diagnostic performance and optimal protocol of frozen section examination (FSE) in SLNB for cervical cancer. METHODS PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure were searched from inception to July 30, 2019, for studies concerning SLNB with FSE in cervical cancer. Sensitivity of FSE in detecting SLN metastasis was the primary diagnostic indicator for evaluation. RESULTS The pooled sensitivity of FSE among 31 eligible studies (1887 patients) was 0.77 (95% CI 0.66-0.85) with high heterogeneity (I2 = 69.73%). Two representative sectioning protocols for FSE were identified from 26 studies, described as equatorial (E-protocol, SLN was bisected) and latitudinal (L-protocol, SLN was cut at intervals). Meta-regression showed that FSE protocol was the only source of heterogeneity (p < 0.001). The pooled sensitivity was 0.86 (95% CI 0.79-0.91, I2 = 0%) and 0.59 (0.46-0.72, I2 = 58.47%) for FSE using L- (13 studies, 650 patients) and E- (13 studies, 1047 patients) protocol, respectively. Among the available data, marcometastases (>2 mm) were missed in 4 and 20 patients; small-volume metastases (≤2 mm) were detected in 13 and 2 patients, respectively, under L- and E-protocol. The pooled sensitivity of FSE using L-protocol would reach 0.97 (95% CI 0.89-0.99) if only marcometastases were considered. These findings were robust to sensitivity analyses. CONCLUSION The sectioning protocol determines the accuracy of FSE in SLNB. With L-protocol, FSE can provide precise intraoperative pathology for SLNB, which enables immediate decision-making for individualized managements.
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Affiliation(s)
- Hua Tu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hai-Feng Gu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - He Huang
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Kai-Jiang Liu
- Department of Gynecologic Oncology, Renji Hospital, Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Jing-Ping Yun
- Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jie-Ping Chen
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xin-Ke Zhang
- Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hideaki Yahata
- Departments of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenzo Sonoda
- Departments of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hao-Yang Zhang
- School of Data and Computer Science, Sun Yat-sen University, Guangzhou, China
| | - Ji-Hong Liu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
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Lu Y, Xu X, Nong XH, Yao DS. Detection of high-risk human papillomavirus DNA in sentinel lymph nodes of patients with cervical cancer. Oncol Lett 2020; 19:2317-2325. [PMID: 32194731 PMCID: PMC7039119 DOI: 10.3892/ol.2020.11337] [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: 03/07/2019] [Accepted: 10/25/2019] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the expression of human papillomavirus (HPV) DNA in sentinel lymph nodes (SLN) in patients with early-stage cervical cancer (CC). In addition, the present study compared the positive rate of SLNs metastasis detected by routine pathological examination, and investigated the value of HPV-DNA in the detection of early CC lymph node micrometastasis. Reverse transcription-quantitative PCR (RT-qPCR) was used in order to evaluate the HPV DNA detection in all CC samples [International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IIA2]. The consistency of HPV-DNA was compared between primary lesions and SLNs. The positive rates of HPV-DNA were compared with pathological diagnosis of SLN metastasis, and the association between the positive expression of HPV-DNA in SLNs and the clinical and pathological parameters of patients with cervical cancer were analyzed. A total of 345 sentinel lymph nodes were detected in 100 patients with IA2-IIA2 CC. The positive rates of RT-qPCR and conventional histopathological detection of SLNs metastasis were 31.6% (109/345) and 12.8% (44/345), respectively (P<0.001). The positive expression of HPV-DNA in SLNs was associated with the clinical stage and tumor diameter (P<0.05), but not with patients' age, depth of cervical invasion, histological grade, lymphatic and vascular space invasion (LVSI), squamous cell carcinoma antigen (SCCAg) (P>0.05). The detection of HPV-DNA expression in pelvic lymph nodes of early CC may be used to improve the detection rate of micrometastasis, guide the postoperative adjuvant therapy more accurately and improve prognosis. Patients with positive HPV-DNA would require closer surveillance than those with negative HPV-DNA.
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Affiliation(s)
- Yan Lu
- Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530000, P.R. China
| | - Xun Xu
- Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530000, P.R. China
| | - Xiu-Hong Nong
- Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530000, P.R. China
| | - De-Sheng Yao
- Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530000, P.R. China
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Alsadoun N, Devouassoux-Shisheboran M. [Pathological process for sentinel lymph node]. Bull Cancer 2020; 107:642-652. [PMID: 32037014 DOI: 10.1016/j.bulcan.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/21/2019] [Indexed: 12/18/2022]
Abstract
Sentinel node is defined as the first node to receive drainage from a primary tumor and seems to reflect the nodal status in the lymphatic drainage of the tumor. Sentinel node technique has modified the pathological examination of lymph nodes, with intraoperative evaluation of sentinel node, allowing immediate lymph node dissection in case of positive sentinel node, and histological ultrastratification to detect occult metastases. This is a literature review of different histological protocols of sentinel node according to different organs. Except for sentinel node in breast cancer and melanoma, intraoperative examination of sentinel node is helpful using frozen section, more sensitive than touch imprint cytology. Sentinel node should be embedded in paraffin block entirely after gross sectioning at two millimeters intervals parallel to the long axis of the node. Histological ultrastaging with serial sections can be helpful, but the number of sections and the interval between them is not codified. Three sections at 200-250 microns can identify the majority of micrometastases (<2mm and >200 microns). Systematic immunohistochemistry of sentinel node is not necessary for breast cancers, since isolated tumor cells do not modify the therapeutic strategy, but remains useful in other organs.
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Affiliation(s)
- Nadjla Alsadoun
- Centre hospitalier Lyon Sud, institut de pathologie multisite des hôpitaux de Lyon, 165, chemin du Grand Revoyet, 69310 Pierre-Bénite, France
| | - Mojgan Devouassoux-Shisheboran
- Centre hospitalier Lyon Sud, institut de pathologie multisite des hôpitaux de Lyon, 165, chemin du Grand Revoyet, 69310 Pierre-Bénite, France.
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Bizzarri N, Pedone Anchora L, Zannoni GF, Santoro A, Valente M, Inzani F, Gallotta V, Conte C, Chiantera V, Fanfani F, Fagotti A, Ferrandina G, Scambia G. Role of one-step nucleic acid amplification (OSNA) to detect sentinel lymph node low-volume metastasis in early-stage cervical cancer. Int J Gynecol Cancer 2020; 30:364-371. [PMID: 31980488 DOI: 10.1136/ijgc-2019-000939] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/27/2019] [Accepted: 01/06/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Growing evidence in the literature supports the accuracy of sentinel lymph node (SLN) biopsy in early-stage cervical cancer. One-step nucleic acid amplification (OSNA) is a rapid assay able to detect cytokeratin 19-mRNA in SLNs, and it can be used for intra-operative detection of low-volume metastases. The aim of this study was to evaluate the rate of low-volume metastasis in SLNs detected by OSNA in patients with early-stage cervical cancer. Secondary aims were to define the sensitivity and the negative predictive value of SLN biopsy assessed with OSNA. METHODS After IRB approval, consecutive patients who underwent surgery for International Federation of Gynecology and Obstetrics stage IA1 with lymph-vascular space involvement to IB1 between November 2017 and July 2019 and had SLN biopsy and pelvic lymphadenectomy were included. SLNs were detected with indocyanine-green cervical injection and sent intra-operatively for OSNA. RESULTS Eighteen patients underwent SLN assessment with OSNA and systematic pelvic lymphadenectomy in the study period. Four (22.2%) patients had unilateral and 14 (77.8%) had bilateral mapping. OSNA detected micro-metastasis in 6/18 (33.3%) patients. All micro-metastases were detected in patients with bilateral SLN mapping. The sensitivity and negative predictive value of SLN in detecting lymph node metastasis with OSNA calculated per pelvic sidewall were 85.7% and 96.1%, respectively. The false negative rate in mapped sidewalls was 14.3%. DISCUSSION This is the first series entirely processing SLNs for OSNA in early-stage cervical cancer. OSNA is able to intra-operatively detect low-volume metastases in SLNs. Further studies are necessary to confirm the accuracy of this technique and to assess survival implications of low-volume metastases detected by OSNA.
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Affiliation(s)
- Nicolò Bizzarri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Luigi Pedone Anchora
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Gian Franco Zannoni
- Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italia, Rome, Italy
| | - Angela Santoro
- Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italia, Rome, Italy
| | - Michele Valente
- Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italia, Rome, Italy
| | - Frediano Inzani
- Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italia, Rome, Italy
| | - Valerio Gallotta
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Carmine Conte
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Università di Palermo, Palermo, Italy
| | - Francesco Fanfani
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy .,Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italia, Rome, Italy
| | - Anna Fagotti
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italia, Rome, Italy
| | - Gabriella Ferrandina
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italia, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italia, Rome, Italy
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Rychlik A, Angeles MA, Migliorelli F, Croce S, Mery E, Martinez A, Ferron G, Guyon F, Querleu D. Frozen section examination of sentinel lymph nodes can be used as a decisional tool in the surgical management of early cervical cancer. Int J Gynecol Cancer 2020; 30:358-363. [PMID: 31911532 DOI: 10.1136/ijgc-2019-000904] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/24/2019] [Accepted: 12/03/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Sentinel lymph node (SLN) detection has been shown to be accurate in detecting lymph node involvement in early-stage cervical cancer. The objective of this study was to evaluate the accuracy of frozen section examination in the assessment of SLN status, with the aim of adequately driving the intra-operative decision. METHODS We designed a retrospective study including patients from two comprehensive cancer centers between January 2001 and December 2018 with early-stage cervical cancer (IA1-IB2 according to International Federation of Gynecology and Obstetrics (FIGO) 2018) undergoing SLN dissection. The SLN procedure was performed using a cervical injection with technetium-99m combined with blue dye or indocyanine green in most cases. RESULTS A total of 176 patients fulfilled inclusion criteria. Bilateral mapping was detected in 153 (86.7%) of them. Nineteen of these patients (12.4%) had SLN involvement: 13 with macrometastases, three with micrometastases and three with isolated tumor cells (ITC). Macrometastatic disease was missed on frozen section in 3/13 FIGO 2018 stage IIIC patients. The three patients with ITC were also missed by frozen section examination.Considering only macrometastases as lymph node involvement, frozen section sensitivity was 76.9% (95% CI 49.7 to 91.8) and negative predictive value (NPV) was 97.9% (95% CI 94.0 to 99.3) in patients with bilateral detection. Including micrometastases, sensitivity was 81.2% (95% CI 57.0 to 93.4) and NPV remained at 97.9% (95% CI 93.9 to 99.3). CONCLUSIONS With a prevalence of final-stage IIIC in patients with pre-operative early-stage cervical cancer of the order of 10% in this series, the NPV of frozen section examination of SLN is very high, with an inferior limit of the CI superior to 94%. Diagnostic accuracy remains acceptable even if micrometastases are considered. The impact of missed ITC has not been established. Frozen section examination can be incorporated in the intra-operative decision algorithm.
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Affiliation(s)
| | - Martina Aida Angeles
- Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Federico Migliorelli
- Department of Women, Children and Adolescents, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Sabrina Croce
- Pathology, Institut Bergonié, Bordeaux, Aquitaine, France
| | - Eliane Mery
- Pathology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Alejandra Martinez
- Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Gwenael Ferron
- Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Frederic Guyon
- Surgical Oncology, Institut Bergonié, Bordeaux, Aquitaine, France
| | - Denis Querleu
- Surgical Oncology, Institut Bergonié, Bordeaux, Aquitaine, France
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Dundr P, Cibula D, Němejcová K, Tichá I, Bártů M, Jakša R. Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer. Arch Pathol Lab Med 2019; 144:1011-1020. [PMID: 31869245 DOI: 10.5858/arpa.2019-0249-ra] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Ultrastaging of sentinel lymph nodes (SLNs) is a crucial aspect in the approach to SLN processing. No consensual protocol for pathologic ultrastaging has been approved by international societies to date. OBJECTIVE.— To provide a review of the ultrastaging protocol and all its aspects related to the processing of SLNs in patients with cervical cancer. DATA SOURCES.— In total, 127 publications reporting data from 9085 cases were identified in the literature. In 24% of studies, the information about SLN processing is entirely missing. No ultrastaging protocol was used in 7% of publications. When described, the differences in all aspects of SLN processing among the studies and institutions are substantial. This includes grossing of the SLN, which is not completely sliced and processed in almost 20% of studies. The reported protocols varied in all aspects of SLN processing, including the thickness of slices (range, 1-5 mm), the number of levels (range, 0-cut out until no tissue left), distance between the levels (range, 40-1000 μm), and number of sections per level (range, 1-5). CONCLUSIONS.— We found substantial differences in protocols used for SLN pathologic ultrastaging, which can impact sensitivity for detection of micrometastases and even small macrometastases. Since the involvement of pelvic lymph nodes is the most important negative prognostic factor, such profound discrepancies influence the referral of patients to adjuvant radiotherapy and could potentially cause treatment failure. It is urgent that international societies agree on a consensual protocol before SLN biopsy without pelvic lymphadenectomy is introduced into routine clinical practice.
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Affiliation(s)
- Pavel Dundr
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - David Cibula
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Kristýna Němejcová
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Ivana Tichá
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Michaela Bártů
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Radek Jakša
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
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Xia WX, Zhang LH, Liu YW. Weighted Gene Co-Expression Network Analysis Reveals Six Hub Genes Involved in and Tight Junction Function in Pancreatic Adenocarcinoma and their Potential Use in Prognosis. Genet Test Mol Biomarkers 2019; 23:829-836. [PMID: 31821092 DOI: 10.1089/gtmb.2019.0122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Pancreatic adenocarcinoma (PAAD) is an aggressive and invasive tumor with poor prognosis. Identifying prognostic biomarkers of PAAD will provide crucial information for developing treatment plans. Methods: In this analysis, a gene-expression dataset, containing RNA-sequencing data recalculated into transcripts per million, was obtained from the UCSC Xena platform. Three thousand nine hundred and seventy six differentially expressed genes were obtained with analysis of variance. Using these data a co-expression network was constructed using weighted gene co-expression network analysis, from which we obtained eight modules. Results: The blue module included 497 genes and demonstrated significant negative correlation with overall survival. Furthermore, pathway analyses demonstrated the involvement of many of these genes in the tight junction pathway, which plays a critical role in PAAD. In addition, we identified six genes in common (i.e., ANXA2 [annexin A2], EPHA2 [erythropoietin-producing hepatocellular class A2], ITGB4 [integrin beta 4], KRT19 [keratin type I cytoskeletal 19], LGALS3 [galectin-3], and S100A14 [S100 calcium binding protein A14]) between the protein-protein interaction and gene co-expression networks that may have critical functions in PAAD. These hub genes were not only highly expressed at the RNA level but also exhibited high expression in the immunohistological data in the Human Protein Atlas Database. Conclusion: Thus, this research clarified the framework of co-expressed gene modules in PAAD and highlighted potential prognostic biomarkers for the clinical diagnosis of PAAD.
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Affiliation(s)
- Wang-Xiao Xia
- Shaanxi Key Laboratory of Brain Disorders, Institute of Basic Translational Medicine, Xi'an Medical University, Xi'an, China
| | - Lin-Heng Zhang
- Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Beijing, China
| | - Yao-Wen Liu
- Shaanxi Key Laboratory of Brain Disorders, Institute of Basic Translational Medicine, Xi'an Medical University, Xi'an, China
- College of Veterinary Medicine, Yunnan Agricultural University, Kunming, China
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Delomenie M, Bonsang-Kitzis H, Bats AS, Ngo C, Balaya V, Xuan HTN, Koual M, Mathevet P, Lecuru F. The clinical implication of lymph nodes micrometastases and isolated tumor cells in patients with cervical cancer: A systematic review. Eur J Obstet Gynecol Reprod Biol 2019; 241:71-76. [DOI: 10.1016/j.ejogrb.2019.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 12/24/2022]
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Diaz-Feijoo B, Temprana-Salvador J, Franco-Camps S, Manrique S, Colás E, Pérez-Benavente A, Gil-Moreno A. Clinical management of early-stage cervical cancer: The role of sentinel lymph node biopsy in tumors ≤2 cm. Eur J Obstet Gynecol Reprod Biol 2019; 241:30-34. [PMID: 31419693 DOI: 10.1016/j.ejogrb.2019.07.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the experience with sentinel lymph node (SLN) biopsy in patients with early-stage cervical cancer at our hospital, and to analyze factors influencing the rate of false negatives. STUDY DESIGN This study was carried out at the Vall d'Hebron Hospital (Barcelona, Spain) between September 2000 and October 2016. All patients underwent SLN biopsy and systematic and bilateral pelvic lymphadenectomy, followed by radical hysterectomy. SLNs were analyzed by the pathologist by staining with hematoxylin-eosin and immunohistochemistry. RESULTS Patients (N = 128) had been diagnosed with early-stage cervical cancer (FIGO-2009 stages 1A2, IB1, and IIA1). The combined SLN detection rate (99-technecium and a blue dye) was 98.4%, bilateral in 76% of the patients. Positive SLNs were found in 19 patients (14.8%). Sensitivity of detection was 79.2% (CI95, 57.9-92.9), false negative rate 20.8% (CI95, 7.1-42.2), and negative predictive value 95.4% (CI95, 89.6-98.5). False negative cases were observed in 5 patients with tumors >2 cm and presenting lymphovascular space invasion. Micrometastases were detected during SLN ultrastaging in 3 patients (2.3%). The median follow-up was 8.24 years and the 5-year overall survival (OS) was 88.4% (CI95, 80.9-93.1). CONCLUSION SLN mapping and biopsy in early-stage cervical cancer is feasible and has high sensitivity to detect patients with initial metastases. The risk of false negatives could be lower in certain groups of patients, such as those with tumors ≤2 cm and no lymphovascular space invasion, but future studies will be required to test this hypothesis.
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Affiliation(s)
- Berta Diaz-Feijoo
- Unit of Gynecological Oncology, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Universitat de Barcelona, IDIBAPS, 08036 Barcelona, Spain.
| | - Jordi Temprana-Salvador
- Department of Pathology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Silvia Franco-Camps
- Department of Gynecology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Susana Manrique
- Department of Anesthesiology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Eva Colás
- Biomedical Research Group in Gynecology, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, CIBERONC, 08035 Barcelona, Spain
| | - Asunción Pérez-Benavente
- Department of Gynecology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Antonio Gil-Moreno
- Department of Gynecology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
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Diaz-Feijoo B, Temprana-Salvador J, Franco-Camps S, Manrique S, Colás E, Pérez-Benavente A, Gil-Moreno A. WITHDRAWN: Clinical management of early-stage cervical cancer: The role of sentinel lymph node biopsy in tumors ≤2 cm. Eur J Obstet Gynecol Reprod Biol X 2019. [DOI: 10.1016/j.eurox.2019.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Niikura H, Tsuji K, Tokunaga H, Shimada M, Ishikawa M, Yaegashi N. Sentinel node navigation surgery in cervical and endometrial cancer: a review. Jpn J Clin Oncol 2019; 49:495-500. [DOI: 10.1093/jjco/hyz062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 04/01/2019] [Accepted: 05/05/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Hitoshi Niikura
- Department of Obstetrics and Gynecology, National Hospital Organization Sendai Medical Center, Sendai
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai
| | - Keita Tsuji
- Department of Obstetrics and Gynecology, National Hospital Organization Sendai Medical Center, Sendai
| | - Hideki Tokunaga
- Department of Obstetrics and Gynecology, National Hospital Organization Sendai Medical Center, Sendai
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, National Hospital Organization Sendai Medical Center, Sendai
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, National Hospital Organization Sendai Medical Center, Sendai
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Kimyon Comert G, Dincer N, Usubutun A. How to Handle Lymphadenectomy Specimens to Identify Metastasis More Accurately in Gynecologic Pathology. Int J Surg Pathol 2018; 27:244-250. [PMID: 30261787 DOI: 10.1177/1066896918802032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To identify the value of processing multiple sections to detect metastasis in lymph nodes (LNs) dissected during gynecologic cancer surgery, and to evaluate the sizes of metastatic LNs in each region to compare with the largest one. MATERIALS AND METHODS This retrospective study included 362 patients who had gynecologic cancer with at least one metastatic LN. Slides of 627 metastatic LN specimens were categorized according to the processing technique into single and more than one section (MOS) groups. In the MOS group, the LNs were cut into 2 or 3 parallel slices because their greatest dimensions exceeded 0.5 cm. Sizes of LN metastatic foci (MF) were measured and defined as follows: MF ⩽2 mm as micrometastasis and MF >2 mm as macrometastasis. The largest LN diameters among the metastatic LNs and the largest LNs in those regions were measured. Groups were compared using the Kruskal-Wallis test. RESULTS Sixty-five (10.3%) of the metastatic LNs included in this study had micrometastases and 40 (6.3%) of them had MF ⩽1 mm. The rate of micrometastasis was higher in the MOS group than in the single-section group (11.8% vs 8.5%, respectively). Twenty-eight percent (n = 175) of metastatic LNs were not the largest, and 55.5% of those were less than 1 cm in diameter. CONCLUSION Methods of LN processing and macroscopic evaluation are not standardized, and processing single sections from LNs may overlook micrometastases. The detection rate of micrometastases can be improved by processing multiple sections from LNs.
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Affiliation(s)
- Gunsu Kimyon Comert
- 1 Etlik Zubeyde Hanim Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nazmiye Dincer
- 2 Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
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Huang BX, Fang F. Progress in the Study of Lymph Node Metastasis in Early-stage Cervical Cancer. Curr Med Sci 2018; 38:567-574. [PMID: 30128863 DOI: 10.1007/s11596-018-1915-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 05/08/2018] [Indexed: 02/06/2023]
Abstract
Spread into regional lymph node is the major route of metastasis in cervical cancer. Although lymph node status is not involved in the International Federation of Gynecology and Obstetrics staging system of uterine cervical cancer, the presence or absence of lymph node metastasis provides important information for prognosis and treatment. In this review, we have attempted to focus on the incidence and patterns of lymph node metastasis, and the issues surrounding surgical assessment of lymph nodes. In addition, the preoperative prediction of lymph node status, as well as the intraoperative assessment by sentinel nodes will be reviewed. Finally, lymph node micrometastasis also will be discussed.
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Affiliation(s)
- Bang-Xing Huang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Fang Fang
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Yahata H, Kobayashi H, Sonoda K, Kodama K, Yagi H, Yasunaga M, Ohgami T, Onoyama I, Kaneki E, Okugawa K, Baba S, Isoda T, Ohishi Y, Oda Y, Kato K. Prognostic outcome and complications of sentinel lymph node navigation surgery for early-stage cervical cancer. Int J Clin Oncol 2018; 23:1167-1172. [PMID: 30094694 DOI: 10.1007/s10147-018-1327-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/30/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND To evaluate the prognostic outcome and surgical complications in patients with early-stage cervical cancer who underwent sentinel node navigation surgery (SNNS) for hysterectomy or trachelectomy. METHODS A total of 139 patients who underwent SNNS using 99mTc phytate between 2009 and 2015 were evaluated. No further lymph node dissection was performed when intraoperative analysis of the sentinel lymph nodes (SLNs) was negative for metastasis. We compared the surgical complications between the SNNS group and 67 matched patients who underwent pelvic lymph node dissection (PLND) after SLN mapping between 2003 and 2008. We also examined the clinical outcomes in the SNNS group. RESULTS The mean number of detected SLNs was 2.5 per patient. Fourteen of the 139 patients in the SNNS group underwent PLND based on the intraoperative SLN results. The amount of blood loss, the operative time, and the number of perioperative complications were significantly less in the SNNS group than in the matched PLND group. There was no recurrence during a follow-up period ranging from 2 to 88 months (median 40 months) in the SNNS group. CONCLUSIONS Using SNNS for early-stage cervical cancer is safe and effective and does not increase the recurrence rate. A future multicenter trial is warranted.
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Affiliation(s)
- Hideaki Yahata
- Department of Obstetrics and Gynecology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Kagoshima University Hospital, Kagoshima, Japan
| | - Kenzo Sonoda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keisuke Kodama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroshi Yagi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masafumi Yasunaga
- Department of Obstetrics and Gynecology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tatsuhiro Ohgami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ichiro Onoyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Eisuke Kaneki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kaoru Okugawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shingo Baba
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuro Isoda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Ohishi
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Zhou M, Wang X, Jiang L, Chen X, Bao X, Chen X. The diagnostic value of one step nucleic acid amplification (OSNA) in differentiating lymph node metastasis of tumors: A systematic review and meta-analysis. Int J Surg 2018; 56:49-56. [PMID: 29753955 DOI: 10.1016/j.ijsu.2018.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 05/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was clarify the diagnostic accuracy of one step nucleic acid amplification (OSNA) for differentiating metastatic lymph nodes from non-metastatic ones in patients with tumors (not including breast cancer). METHODS A systematic literature search for original diagnostic studies was performed in PubMed. Findings were pooled by using combined effect models and hierarchic summary receiver operating characteristic curve models. Meta-regression analysis and threshold effect evaluating were performed to explore the sources of heterogeneity affected classification accuracy. RESULTS 19 studies (803 positive and 4594 negative lymph nodes) were analyzed, including 4 different tumor types (head and neck cancers, gastrointestinal cancers, lung cancer and gynecological malignancies). In the studies of head and neck cancers the pooled sensitivity, specificity and area under the curve (AUC) of the OSNA method were 0.85(0.79-0.89), 0.96(0.92-0.98) and 0.91 (0.88-0.93), respectively. Similarly, the corresponding values in the studies of gastrointestinal cancers were 0.90(0.85-0.94), 0.96(0.94-0.98) and 0.97 (0.96-0.99), respectively. Because of limited number of studies, the other two tumor types were inestimable in the subsequent meta-analyses. CONCLUSIONS Pooled data suggest that the OSNA assay has a high diagnostic accuracy for the detection of lymph node metastases. For wide spread implementation, additional studies on other different types of tumors are warranted.
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Affiliation(s)
- Min Zhou
- Department of Thyroid and Breast Surgery, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu 214200, China.
| | - Xuzhen Wang
- Department of Thyroid and Breast Surgery, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu 214200, China.
| | - Liping Jiang
- Department of Gynecology and Obstetrics, Wuxi Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214000, China.
| | - Xu Chen
- Department of Thyroid and Breast Surgery, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu 214200, China.
| | - Xin Bao
- Department of Thyroid and Breast Surgery, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu 214200, China.
| | - Xiang Chen
- Department of Thyroid and Breast Surgery, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu 214200, China.
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Samouëlian V, Mechtouf N, Leblanc E, Cardin GB, Lhotellier V, Querleu D, Révillion F, Rodier F. Sensitive molecular detection of small nodal metastasis in uterine cervical cancer using HPV16-E6/CK19/MUC1 cancer biomarkers. Oncotarget 2018; 9:21641-21654. [PMID: 29774091 PMCID: PMC5955143 DOI: 10.18632/oncotarget.24956] [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: 05/01/2016] [Accepted: 03/15/2018] [Indexed: 12/02/2022] Open
Abstract
Metastatic nodal involvement is a critical prognostic factor in uterine cervical cancer (UCC). To improve current methods of detecting UCC metastases in lymph nodes (LNs), we used quantitative PCR (qPCR) to assess mRNA expression of potential metastatic biomarkers. We found that expression of HPV16-E6, cytokeratin19 (CK19), and mucin1 (MUC1) is consistently upregulated in tumors and metastatic tissues, supporting a role for these genes in UCC progression. These putative biomarkers were able to predict the presence of histologically positive metastatic LNs with respective sensitivities and specificities of 82% and 99% (CK19), 76% and 95% (HPV16-E6), and 76% and 78% (MUC1). While the biomarkers failed to detect 1.7% to 2.2% of the histologically positive LNs when used individually, combining CK19 and HPV16-E6 enhanced sensitivity and specificity to 100% and 94%, respectively. To explore the sensitivity of qPCR-based detection of varying proportions of invading HPV16-positive UCC cells, we designed a LN metastasis model that achieved a fresh cell detection limit of 0.008% (1:12500 HPV16-positive to HPV16-negative cells), and a paraffin-embedded, formalin-fixed (PEFF) detection limit of 0.02% (1:5000 HPV16-positive to HPV16-negative cells), both of which are within the theoretical detection limit for micrometastasis. Thus, HPV E6/E7 oncogenes may be useful targets for the ultrasensitive detection of nodal involvements like micrometastases in fresh or archived tissue samples. Moreover, our results suggest that the biomarker combination of CK19/HPV-E6 could support a real-time intraoperative strategy for the detection of small, but potentially lethal, metastatic nodal involvements in fresh UCC tissues.
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Affiliation(s)
- Vanessa Samouëlian
- CRCHUM et Institut du cancer de Montréal, Montreal, QC, Canada.,Université de Montréal, Département d'Obstétrique Gynécologie, Montreal, QC, Canada.,CHUM, Service de Gynécologie oncologique, Montreal, QC, Canada
| | - Nawel Mechtouf
- CRCHUM et Institut du cancer de Montréal, Montreal, QC, Canada
| | - Eric Leblanc
- Department of Surgery - Centre Oscar Lambret, Lille Cedex, France
| | | | - Valérie Lhotellier
- Laboratory of Human Molecular Oncology - Centre Oscar Lambret, Lille Cedex, France
| | | | - Françoise Révillion
- Laboratory of Human Molecular Oncology - Centre Oscar Lambret, Lille Cedex, France
| | - Francis Rodier
- CRCHUM et Institut du cancer de Montréal, Montreal, QC, Canada.,Université de Montréal, Département de Radiologie, Radio-Oncologie et Médicine Nucléaire, Montreal, QC, Canada
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Kaczka KA, Pomorski L. One-step nucleic acid amplification analysis of sentinel lymph nodes in papillary thyroid cancer patients. Arch Med Sci 2017; 13:1416-1426. [PMID: 29181073 PMCID: PMC5701692 DOI: 10.5114/aoms.2017.65466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 10/02/2016] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION It is essential to look for methods to define the need for central lymphadenectomy for papillary thyroid cancer patients. The aim is to determine the efficacy of one-step nucleic acid amplification (OSNA) and sentinel lymph node (SLN) biopsy in the intraoperative detection of nodal involvement. MATERIAL AND METHODS This prospective, experimental study enrolled 49 patients with clinically negative lymph nodes. Intraoperatively, 1% Patent Blue dye was injected intratumorally. Lymph nodes that stained blue were defined as SLNs. They were directly cut into blocks at 2-mm intervals. Nonadjacent blocks were subjected to either the OSNA assay or histological examination. RESULTS Sixty-five SLNs were found in 43 (87.8%) patients. There were 20 (30.8%) histopathologically positive SLNs. According to the OSNA, 22 (33.8%) SLNs were positive. The OSNA results were different from histopathology in 8 (12.3%) SLNs. The OSNA gave a positive result in 5 (7.7%) SLNs, while they were not involved according to the histopathology. However, OSNA upstaged N status from N0 to N1 only in 2 (3.1%) patients. Inverse results (histopathology +, OSNA-) were obtained in 3 (4.6%) SLNs. Positive and negative predictive values (PPV and NPV) for OSNA were 0.77 and 0.93, respectively. The concordance rate between examinations was 85.5%. CONCLUSIONS In some patients with clinically negative lymph nodes, OSNA and SLN biopsy may prevent unnecessary central lymphadenectomy. On the other hand, the sentinel lymph node biopsy may reveal the presence of potentially involved sentinel lymph nodes outside the central compartment. These SLNs can also be assessed by means of OSNA.
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Affiliation(s)
- Krzysztof A Kaczka
- Department of General and Oncological Surgery, Medical University of Lodz, Lodz, Poland
| | - Lech Pomorski
- Department of General and Oncological Surgery, Medical University of Lodz, Lodz, Poland
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Liu M, An J, Huang M, Wang L, Tu B, Song Y, Ma K, Wang Y, Wang S, Zhu H, Xu N, Wu L. MicroRNA-492 overexpression involves in cell proliferation, migration, and radiotherapy response of cervical squamous cell carcinomas. Mol Carcinog 2017; 57:32-43. [PMID: 28802022 DOI: 10.1002/mc.22717] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 08/01/2017] [Accepted: 08/08/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Mei Liu
- Laboratory of Cell and Molecular Biology & State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing P. R. China
| | - Jusheng An
- Department of Gynecological Oncology; National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing P. R. China
| | - Manni Huang
- Department of Gynecological Oncology; National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing P. R. China
| | - Liming Wang
- Department of Abdominal Surgery; National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing P. R. China
| | - Binbin Tu
- Department of Gynecological Oncology; National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing P. R. China
| | - Yan Song
- Department of Pathology; National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing P. R. China
| | - Kai Ma
- Laboratory of Cell and Molecular Biology & State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing P. R. China
| | - Yu Wang
- Laboratory of Cell and Molecular Biology & State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing P. R. China
| | - Shuren Wang
- Laboratory of Cell and Molecular Biology & State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing P. R. China
| | - Hongxia Zhu
- Laboratory of Cell and Molecular Biology & State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing P. R. China
| | - Ningzhi Xu
- Laboratory of Cell and Molecular Biology & State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing P. R. China
- State Key Laboratory of Biotherapy and Cancer Center; West China Hospital; Sichuan University, Collaborative Innovation Center for Biotherapy; Chengdu P. R. China
| | - Lingying Wu
- Department of Gynecological Oncology; National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing P. R. China
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Ferrandina G, Pedone Anchora L, Gallotta V, Fagotti A, Vizza E, Chiantera V, De Iaco P, Ercoli A, Corrado G, Bottoni C, Fanfani F, Scambia G. Can We Define the Risk of Lymph Node Metastasis in Early-Stage Cervical Cancer Patients? A Large-Scale, Retrospective Study. Ann Surg Oncol 2017; 24:2311-2318. [PMID: 28608117 DOI: 10.1245/s10434-017-5917-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy has emerged as one of the most appreciated techniques for reducing the rate of complete lymph node dissection (LND) performed in patients with early-stage cervical cancer (ECC). However, its performances are still a matter of debate and, to improve them, international guidelines recommend performing at least unilateral LND in case of SLN mapping. In a prior study, we identified a group of patients without evidence of lymph node metastasis (LNM). Our objective is to define a precise risk of LNM for each ECC patient in order to significantly tailor surgery for ECC. METHODS Clinical and pathological data of ECC patients were retrospectively collected by eight Italian institutions. Chi-square test or Fisher's exact test along with logistic regression analysis was used to determine the association of each variable between patients with or without LNM. Results of logistic regression have been used as a basis to calculate the probability to harboring LNM. RESULTS A total of 463 ECC patients were identified. No LNM was detected among the 161 (34.8%) patients who met the criteria and were defined as Very Low Risk. In the other 302 patients, the precise risk of LNM was calculated, and it was <1% in 31 (10.3%) patients. CONCLUSIONS Defining the precise risk of LNM could lead to proper selection of patients in whom any lymph nodal procedure, including SLN, could be avoided.
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Affiliation(s)
- Gabriella Ferrandina
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy. .,Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy.
| | - Luigi Pedone Anchora
- Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Valerio Gallotta
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - Anna Fagotti
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.,Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology, Fondazione "Giovanni Paolo II", Campobasso, Italy
| | - Pierandrea De Iaco
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology, University of Eastern Piedmond, Novara, Italy
| | - Giacomo Corrado
- Gynecologic Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Carolina Bottoni
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - Francesco Fanfani
- Department of Medicine and Aging Sciences, University "G. D'Annunzio", Chieti, Pescara, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.,Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy
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Yao H, Yang Z, Liu Z, Miao X, Yang L, Li D, Zou Q, Yuan Y. Glypican-3 and KRT19 are markers associating with metastasis and poor prognosis of pancreatic ductal adenocarcinoma. Cancer Biomark 2017; 17:397-404. [PMID: 27689616 DOI: 10.3233/cbm-160655] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor with metastasis in most patients at diagnosis. The molecular mechanisms associated with its high malignancy have not been fully elucidated. This study investigated the clinicopathological significances of GPC3 and KRT19 expression in PDAC. METHODS GPC3, KRT19, and CA19-9 protein expression were measured by immunohistochemistry. RESULTS GPC3 and KRT19 protein levels were overexpressed in PDAC tumors compared to normal pancreatic tissues, benign pancreatic tissues, and peritumoral tissues (P< 0.01). The percentage of positive GPC3 and KRT19 expression were significantly higher in PDAC patients with larger tumor size, poorly differentiated tumor, lymph node metastasis, invasion, and TNM stage III/IV disease than in patients with small tumor size, well-differentiated tumor, no lymph node metastasis and invasion, as well as TNM stage I/II stage disease (P< 0.05 or P< 0.01). Benign pancreatic lesions with positive GPC3 and KRT19 protein expression exhibited dysplasia or intraepithelial neoplasia. Kaplan-Meier survival analysis showed that PDAC patients with positive GPC3 and KRT19 expression survived significantly shorter than patients with negative GPC3 and KRT19 expression (P < 0.05 or P< 0.001). Cox multivariate analysis revealed that positive GPC3 and KRT19 expression were independent poor prognosis factors in PDAC patients. CONCLUSIONS GPC3 and KRT19 overexpression are associated with carcinogenesis, progression, and poor prognosis in patients with PDAC and a valuable biomarker for diagnosis of PDAC.
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Affiliation(s)
- Hongliang Yao
- Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhulin Yang
- Research Laboratory of Hepatobiliary Diseases, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ziru Liu
- Research Laboratory of Hepatobiliary Diseases, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiongying Miao
- Research Laboratory of Hepatobiliary Diseases, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Leping Yang
- Research Laboratory of Hepatobiliary Diseases, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Daiqiang Li
- Department of Pathology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiong Zou
- Department of Pathology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuan Yuan
- Department of Pathology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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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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Siesto G, Romano F, Fiamengo B, Vitobello D. Sentinel Node Mapping Using Indocyanine Green and Near-infrared Fluorescence Imaging Technology for Uterine Malignancies: Preliminary Experience With the Da Vinci Xi System. J Minim Invasive Gynecol 2016; 23:470-1. [PMID: 26767824 DOI: 10.1016/j.jmig.2015.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 12/29/2015] [Accepted: 12/29/2015] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE Sentinel lymph node (SLN) mapping has emerged as the new frontier for the surgical staging of apparently early-stage cervical and endometrial cancer. Different colorimetric and radioactive tracers, alone and in combination, have been proposed with encouraging results. Fluorometric mapping using indocyanine green (ICG) appears to be a suitable and attractive alternative to provide reliable staging [1-4]. DESIGN In this video, we present the technique of SLN mapping in 2 cases (1 endometrial and 1 cervical cancer, respectively) using ICG and the near-infrared technology provided by the newest Da Vinci Xi robotic system (Intuitive Surgical Inc., Sunnyvale, CA). Together we report the results of our preliminary experience on the first 20 cases performed. The new robotic Da Vinci Xi system was available at our institution since May 2015. INTERVENTION Upon institutional review board/ethical committee approval, all consecutive patients with early-stage endometrial and cervical cancer who were judged suitable for robotic surgery have been enrolled for SLN mapping with ICG. We adopted the Memorial Sloan Kettering Cancer Center SLN algorithm; the tracer was delivered into the cervix in all cases. Four milliliters (1.25 mg/mL) of ICG was injected divided into the 3- and 9-o'clock positions of the cervix alone, with 1 mL deep into the stroma and 1 mL submucosally at the skin incision. Sentinel lymph nodes were examined with a protocol including both ultrastaging with immunohistochemistry [3] and 1-step nucleic acid amplification assay [5,6] under a parallel protocol of study. During the study period, 20 cases were managed; 14 and 6 patients had endometrial and cervical cancer, respectively. SLN was detected in all cases (20/20, 100%). Bilateral SLNs were detected in 17 of 20 (85.0%) cases. Based on preoperative and intraoperative findings, 13 (65.0%) patients received systematic pelvic lymphadenectomy after SLN mapping. Three (15.0%) patients had microscopic nodal metastases on SLN. No patients had positive regional nodes other than SLN. No perioperative complications were recorded. CONCLUSION SLN mapping has been acknowledged by the National Comprehensive Cancer Network guidelines as a viable option for the management of selected uterine malignancies [7,8]. Currently, the near-infrared technology built in the Da Vinci Xi system provides an enhanced real-time imaging system that improves the advantages given by ICG. Together with our experience, these conditions indicate that SLN mapping is an effective and safe procedure with high overall detection and low false-negative rates.
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Affiliation(s)
- Gabriele Siesto
- Gynecologic Unit, Humanitas Clinical and Research Hospital, Milan, Italy.
| | - Fabrizio Romano
- Gynecologic Unit, Humanitas Clinical and Research Hospital, Milan, Italy
| | - Barbara Fiamengo
- Pathology Unit, Humanitas Clinical and Research Hospital, Milan, Italy
| | - Domenico Vitobello
- Gynecologic Unit, Humanitas Clinical and Research Hospital, Milan, Italy
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Zhou J, Ran J, He ZY, Quan S, Chen QH, Wu SG, Sun JY. Tailoring Pelvic Lymphadenectomy for Patients with Stage IA2, IB1, and IIA1 Uterine Cervical Cancer. J Cancer 2015; 6:377-81. [PMID: 25767608 PMCID: PMC4349878 DOI: 10.7150/jca.10968] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/21/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose: The purpose of this study was to assess the risk factors for pelvic lymph node metastasis (PLNM) in patients with early-stage uterine cervical cancer. Methods: A total of 192 patients with early-stage uterine cervical cancer (FIGO stage IA2, IB1, and IIA1) receiving radical hysterectomy with pelvic lymphadenectomy were included in the statistical analysis. Results: Thirty-six patients (18.8%) developed PLNM, and the incidences of PLNM in patients with stage IA2, stage IB2, and stage IIA1 were 0% (0/6), 13.9% (20/144), and 38.1% (16/42), respectively. The most common location of PLNM was the obturator lymph node. Univariate analysis showed that stage IIA1 (p < 0.001), tumor size greater than 3 cm (p = 0.019), deep-full thickness stromal invasion (p < 0.001), and lymphovascular invasion (p = 0.001) were associated with PLNM. Multivariate analysis showed that deep or full-thickness stromal invasion and lymphovascular invasion were significantly and independently associated with PLNM (p < 0.05 for both). The incidence of PLNM was 34.9% and 28.7% in patients with deep-full thickness stromal invasion and lymphovascular invasion, respectively, but that was only 5.7% and 9.2% in patients with superficial-middle stromal invasion and absence of lymphovascular invasion, respectively. Conclusion: Patients with superficial-middle stromal invasion and without lymphovascular invasion may be avoided pelvic lymphadenectomy in stage IA2, IB1, IIA1 uterine cervical cancer.
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Affiliation(s)
- Juan Zhou
- 1. Xiamen Cancer Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Jing Ran
- 2. Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Zhen-Yu He
- 3. Sun Yat-sen University Cancer Center, Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Song Quan
- 2. Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Qiong-Hua Chen
- 1. Xiamen Cancer Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - San-Gang Wu
- 4. Xiamen Cancer Center, Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Jia-Yuan Sun
- 3. Sun Yat-sen University Cancer Center, Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
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Tokunaga H, Watanabe Y, Niikura H, Nagase S, Toyoshima M, Shiro R, Yokoyama Y, Mizunuma H, Ohta T, Nishiyama H, Watanabe T, Sato N, Sato N, Sugiyama T, Takano T, Takahashi F, Yaegashi N. Outcomes of abdominal radical trachelectomy: results of a multicenter prospective cohort study in a Tohoku Gynecologic Cancer Unit. Int J Clin Oncol 2014; 20:776-80. [PMID: 25391812 DOI: 10.1007/s10147-014-0763-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study aimed to evaluate surgical, pregnancy, and prognostic outcomes of radical abdominal trachelectomy (RAT) for Japanese patients with early-stage cervical cancer. METHODS This was a multicenter prospective cohort study conducted in member facilities of Tohoku Gynecologic Cancer Unit. Patients with FIGO 1A-1B1 squamous cell carcinoma were included. RESULTS A total of 42 patients were registered in this study, and all patients underwent planned RAT. The median stromal invasion and median horizontal spread of resected specimens were 4.6 (range 1.0-10.0) and 12.4 mm (range 3.0-28.0), respectively. The median surgical time and median blood loss were 304 min (range 233-611) and 848 mL (range 250-3984), respectively. Five patients (11.9 %) received blood transfusion. Five of 18 (27.8 %) patients who attempted to conceive achieved pregnancy, and 3 patients had healthy babies. However, all pregnancies required assisted reproductive technology with in-vitro fertilization and embryo transfer. Four patients (9.5 %) received postoperative adjuvant therapy, and 3 patients (7.1 %) developed disease recurrence. CONCLUSIONS RAT may be safely performed for Japanese patients with FIGO 1A-1B1 squamous cell carcinoma of the cervix, even in educational medical facilities. However, less-invasive surgery should be considered more often to improve pregnancy outcomes.
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Affiliation(s)
- Hideki Tokunaga
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Nagai T, Niikura H, Okamoto S, Nakabayashi K, Matoda M, Utsunomiya H, Nagase S, Watanabe M, Takeshima N, Yaegashi N. A new diagnostic method for rapid detection of lymph node metastases using a one-step nucleic acid amplification (OSNA) assay in endometrial cancer. Ann Surg Oncol 2014; 22:980-6. [PMID: 25190122 DOI: 10.1245/s10434-014-4038-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND To improve lymph node (LN) metastasis identification for patients with endometrial cancer (EC), this study assessed the usefulness of molecular biologic techniques using a one-step nucleic acid amplification (OSNA) assay. METHODS Using quantitative reverse transcription polymerase chain reaction (qRT-PCR), an optimal mRNA marker was selected, and its expression was compared between histopathologically positive and negative LNs using an OSNA assay. The authors determined copy number cutoff values and evaluated the diagnostic performance of this OSNA assay using sentinel lymph nodes (SLNs). They also investigated whether an OSNA assay could detect LN metastases with sensitivity and specificity equivalent to the 2-mm-interval histopathology method. RESULTS For analysis of EC samples, cytokeratin 19 (CK19) was selected as a useful mRNA marker for the OSNA assay. When the cutoff value was set at 250 copies (using 215 LNs from 70 patients), an OSNA assay using CK19 mRNA had a sensitivity of 93.3%, a specificity of 99.5%, and a concordance rate of 99.1%. For performance evaluations using SLNs (120 histopathologically negative LNs and 17 histopathologically positive LNs from 35 patients), a OSNA assay using CK19 mRNA had a sensitivity of 82.4%, a specificity of 99.2%, a positive predictive value of 93.3%, and a concordance rate of 97.1%. Thus, an OSNA assay using CK19 mRNA provided results equivalent to those with the 2-mm-interval histopathology method. CONCLUSIONS The study data demonstrated that an OSNA assay using CK19 mRNA was applicable for detecting LN metastases in EC. Combined analysis using an OSNA assay and SLNs may improve individualized treatments according to LN metastatic status.
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Affiliation(s)
- Tomoyuki Nagai
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Japan
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Can Pelvic Lymphadenectomy be Omitted in Stage IA2 to IIB Uterine Cervical Cancer? Int J Gynecol Cancer 2014; 24:1072-6. [DOI: 10.1097/igc.0000000000000163] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectivesThe aims of this study were to predict pelvic lymph node metastasis in uterine cervical cancer before surgery and to evaluate the potential efficacy of omitting pelvic lymphadenectomy.Materials and MethodsA total of 163 patients with invasive uterine cervical cancer in FIGO stage IA2 to IIB, all of whom underwent primary radical hysterectomy with pelvic lymphadenectomy, participated in this study.ResultsThe incidences of pelvic lymph node metastasis in stage IA2, stage IB1, stage IB2, stage IIA, and stage IIB cervical cancer were 0% (0/12), 17% (13/76), 22% (6/27), 33% (8/24), and 63% (15/24), respectively. A significant difference was observed in overall survival with nodal metastasis status (P< 0.0001). Univariate analysis revealed that parametrial invasion (P< 0.0001), tumor markers (P= 0.0006), tumor size greater than 2 cm (P< 0.0001), tumor size less than 3 cm (P= 0.0009), and tumor size greater than 4 cm (P= 0.0024) were correlated with pelvic lymph node metastasis. However, multivariate analysis revealed that parametrial invasion (P= 0.01; odds ratio, 3.37; 95% confidence interval, 1.31–9.0) and tumor size greater than 2 cm (P= 0.005; odds ratio, 4.93; 95% confidence interval, 1.54–22.01) were independently associated with nodal metastasis.ConclusionsPelvic lymphadenectomy may be avoided in patients with negative parametrial invasion and a tumor size less than 2 cm, thereby minimizing postoperative complications.
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[Sentinel lymph node in low stage cervical cancers. Current data. Quality assurance. Prospects]. Bull Cancer 2014; 101:349-53. [PMID: 24793625 DOI: 10.1684/bdc.2014.1928] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sentinel node biopsy appears as a promising technique for the assessment of nodal disease in early cervical cancers. Selection of a population with a low risk of nodal metastasis, a minimal training, and simple rules allow a low false negative rate. Sentinel node biopsy provides supplementary information, such as anatomical information (nodes outside of routine lymphadenectomy areas) and histological information (isolated tumors cells and micrometastases).
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