One-step nucleic acid amplification testing in medullary thyroid cancer lymph nodes: a case series

The evolving role of one-step nucleic acid amplification (OSNA) for the intra-operative detection of lymph node metastases: A diagnostic accuracy meta-analysis

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.

The utility of Leventhal's model in the analysis of the psycho-behavioral implications of familial cancer - a literature review

INTRODUCTION

We aim to highlight the utility of this model in the analysis of the psycho-behavioral implications of family cancer, presenting the scientific literature that used Leventhal's model as the theoretical framework of approach.

MATERIAL AND METHODS

A systematic search was performed in six databases (EBSCO, ScienceDirect, PubMed Central, ProQuest, Scopus, and Web of Science) with empirical studies published between 2006 and 2015 in English with regard to the Common Sense Model of Self-Regulation (CSMR) and familial/hereditary cancer. The key words used were: illness representations, common sense model, self regulatory model, familial/hereditary/genetic cancer, genetic cancer counseling. The selection of studies followed the PRISMA-P guidelines (Moher et al., 2009; Shamseer et al., 2015), which suggest a three-stage procedure.

RESULTS

Individuals create their own cognitive and emotional representation of the disease when their health is threatened, being influenced by the presence of a family history of cancer, causing them to adopt or not a salutogenetic behavior. Disease representations, particularly the cognitive ones, can be predictors of responses to health threats that determine different health behaviors. Age, family history of cancer, and worrying about the disease are factors associated with undergoing screening. No consensus has been reached as to which factors act as predictors of compliance with cancer screening programs.

CONCLUSIONS

This model can generate interventions that are conceptually clear as well as useful in regulating the individuals' behaviors by reducing the risk of developing the disease and by managing as favorably as possible health and/or disease.

One-step nucleic acid amplification analysis of sentinel lymph nodes in papillary thyroid cancer patients

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.