Intraoperative assessment of sentinel lymph nodes in breast cancer

Layfield, David; Agrawal, Avi; Roché, H.; Cutress, R.I.

doi:10.1002/bjs.7229

Cited by 99 publications

(82 citation statements)

References 73 publications

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“…Many studies have already shown that FS does not allow for accurate diagnosis in all cases, since its high specificity does not associate with high sensitivity [19,20]. OSNA is a relatively recent technique that detects mRNA expression of epithelial breast cancer marker cytokeratine 19 (CK19) in the biopsied lymph node.…”

Section: Discussionmentioning

confidence: 99%

“…However, the procedure is expensive, labor intensive, time-consuming and operator dependent. Besides, FS determines an irreversible tissue loss due to cryostat processing, causing a more difficult and inaccurate detection of micro-and sometimes even macrometastatic involvement at routine histopathology [19]. As far as costs are concerned, FS is at least three times more expensive than TIC, considering that the cost of evaluating two SLNs using TIC is 131$ compared to 356$ for FS [27].…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Sentinel Lymph Node Intraoperative Touch Imprint Cytology in Breast Cancer Surgery

Iacuzzo¹,

Troian²,

Bonadio³

et al. 2017

J Mol Biomark Diagn

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Background: One of the strongest prognostic factor for breast cancer is the regional lymph node status, which can be evaluated intraoperatively by sentinel lymph node biopsy. Many methods (e.g. frozen section, touch imprint cytology (TIC) and one-step nucleic-acid amplification) are available to detect metastatic cells in axillary lymph nodes. The aim of this study is to evaluate the feasibility of using TIC to detect metastatic cells in sentinel lymph nodes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of Sentinel Lymph Node Intraoperative Touch Imprint Cytology in Breast Cancer Surgery

Iacuzzo¹,

Troian²,

Bonadio³

et al. 2017

J Mol Biomark Diagn

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“…These results are reasonable, because 2 mm-section histology can miss metastases <2 mm between the cut surfaces, and the falsenegative rate of intraoperative FS histology, mainly resulting from failure to detect micrometastases, has been found to range from approximately 30% to 40% compared with the final pathological results. 9 The OSNA assay could detect more sentinel lymph node metastases than could FS histology from primary tumors without lymphovascular or fat invasion, or from microinvasive tumors. Several studies have shown that primary tumors with nodal micrometastases are smaller than those with macrometastases.…”

Section: Discussionmentioning

confidence: 99%

“…However, the false-negative rate of FS histology, mainly resulting from failure to detect micrometastases, have been found to range from 26% to 43% compared with the final pathological results. 9 The one-step nucleic acid amplification (OSNA) assay (Sysmex, Kobe, Japan) is a rapid molecular detection procedure that analyses lymph node metastases by detection and amplification of cytokeratin 19 (CK19) mRNA. 10 This assay could accurately detect clinically relevant nodal metastases of >0.2 mm at rates comparable to conventional pathological examination, in at least half of the lymph nodes tested.…”

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confidence: 99%

Intraoperative molecular assay for sentinel lymph node metastases in early stage breast cancer

Osako

Iwase

Kimura

et al. 2011

Cancer

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BACKGROUND: Conventional histopathological examination is limited in measuring accurate total metastatic volume in a lymph node. Recently, a molecular-based procedure to detect lymph node metastases, one-step nucleic acid amplification (OSNA) assay, has been developed. OSNA assay can assess a whole lymph node and yields semiquantitative results. The authors compared the performance in intraoperative detection of sentinel lymph node metastases with OSNA assay using a whole lymph node versus routine frozen section (FS) histology with a 2 mm-sectioned lymph node. METHODS: Subjects comprised 531 consecutive patients diagnosed with OSNA assay and 618 consecutive patients diagnosed with FS histological examination. The authors compared the sentinel lymph node-positive rate between the OSNA and FS cohorts, and investigated characteristics of patients for whom OSNA could detect metastases but FS could not. OSNA (þ) was defined as micrometastasis, and OSNA (þþ) and (þI) were defined as macrometastasis. RESULTS: OSNA assay detected more cases of sentinel lymph node metastases than FS histology (OSNA 121 of 531, 22.8% vs FS 109 of 618, 17.6%; P ¼ .036), particularly micrometastases (46 of 531, 8.7% vs 28 of 618, 4.5%; P ¼ .0064). There was no difference in macrometastasis detection between OSNA and FS (75 of 531, 14.1% vs 81 of 618, 13.1%; P ¼ .68). OSNA detected more metastases than FS in postmenopausal patients (77 of 302, 25.5% vs 43 of 351, 12.3%; P < .0001), and in tumors without fat invasion (23 of 156, 14.7% vs 6 of 151, 4.0%; P ¼ .012) or lymphovascular invasion (67 of 395, 17.0% vs 45 of 458, 9.8%; P ¼ .042). CONCLUSIONS: Intraoperative OSNA assay detects more sentinel lymph node metastases, particularly micrometastases, than does FS histology. OSNA assay can also detect more metastases in postmenopausal patients or from less aggressive primary tumors compared with FS histology. Cancer 2011;117:4365-

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“…These include frozen section analysis, touch imprint cytology and molecular analysis. The sensitivity and specificities of these techniques vary with 57% -74% sensitivity and 100% specificities reported for frozen section [3] [5], 63% sensitivity and 99% specificity for touch imprint cytology [6] and sensitivities of between 95% -98% with specificities of up to 97% for molecular assays [6]. Tests which utilise molecular assays use either reverse transcriptase polymerase chain reactions (RT-PCR) or reverse transcriptase loop-mediated isothermal amplifications (RT-LAMP).…”

Section: Introductionmentioning

confidence: 99%

Sensitivity and Specificity of Pre-Operative Staging of the Axilla When Using OSNA in Breast Cancer Patients

Horsnell¹,

Choudhry²,

Urriza-Rodriguez³

et al. 2016

ABCR

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Introduction: All patients with a new diagnosis of breast cancer undergo pre-operative axillary ultrasound (US) and biopsy to identify axillary metastases. The efficacy of this approach at identifying metastatic disease is particularly important if an intra-operative technique of assessment is used. This paper is the first to report the sensitivity and specificity of pre-operative axillary ultrasound within the context of the routine use of OSNA (one step nucleic acid amplification) (Sysmex, Japan), a molecular assay technique for the intra-operative analysis of axillary lymph nodes. This knowledge will help counsel patients prior to the procedure and inform economic analysis of the implications of this approach. Method: Consecutive patients diagnosed with invasive breast cancer between July 2009 and February 2012 at a single centre were identified by interrogation of MDT (multi disciplinary team) and surgical databases and a prospective database of all patients undergoing OSNA analysis. A standardised data collection sheet was used to record tumour characteristics and the nodal stage for each patient. These results were used to document the efficacy of preoperative US and biopsy of the axilla in comparison to intraoperative OSNA analysis. The data were then compared between two groups of patients, those whose nodes had been assessed using OSNA (the OSNA group) and those nodes had been tested using standard histopathological examination (the non-OSNA group). Results: A total of 377 eligible patients were identified. Within the OSNA group (n = 240) the sensitivity of pre-operative axillary US was 29% which rose to 41% when micro-metastases were excluded. A specificity and positive predictive value of 100% was recorded. The negative predictive value was 74%. There were no significant differences to the efficacy when the nodes were assessed with standard histopathology. The detection rate of micro-metastases was significantly higher in the OSNA group (P = 0.001), but there was no statistically significant difference in those with macro-metastases (P = 0.457). Conclusions: There are no * Corresponding author. J. D. Horsnell et al. 104significant differences in the sensitivity and specificity achieved by pre-operative axillary US when compared to either post operative histopathology or OSNA molecular analysis as the gold standard. OSNA, however, does increase the detection of micro-metastases.

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Intraoperative assessment of sentinel lymph nodes in breast cancer

Cited by 99 publications

References 73 publications

Evaluation of Sentinel Lymph Node Intraoperative Touch Imprint Cytology in Breast Cancer Surgery

Evaluation of Sentinel Lymph Node Intraoperative Touch Imprint Cytology in Breast Cancer Surgery

Intraoperative molecular assay for sentinel lymph node metastases in early stage breast cancer

Sensitivity and Specificity of Pre-Operative Staging of the Axilla When Using OSNA in Breast Cancer Patients

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