Utility of the GeneSearch breast lymph node assay for the rapid evaluation of sentinel lymph nodes in breast cancer

Abstract

BACKGROUND:The potential for reducing the need for second surgery for axillary lymph node dissection (ALND) has made the intraoperative evaluation of sentinel lymph nodes (SLNs) attractive. The goal of the current study was to evaluate the clinical application of the breast lymph node (BLN) assay, a real-time reverse transcriptase-polymerase chain reaction assay for SLN metastases, by comparing this test with routine pathologic examination. METHODS: A total of 117 patients with breast cancer underwent breast surgery with SLN biopsy. Each SLN was cut in half along the plane of the longest dimension. Half of each lymph node was examined by the 2 markers of the BLN assay, mammaglobin and cytokeratin 19, and the other half was examined by hematoxylin and eosin staining (H&E) and immunohistochemical staining (IHC) for pancytokeratins. RESULTS: A total of 204 SLNs were obtained from 117 patients. H&E staining identified metastases in 31 SLNs (15.2%), and IHC staining detected metastases in 6 SLNs; 40 SLNs from 32 patients were found to be positive for metastasis using the BLN assay. The assay results were correlated with the pathologic diagnoses by H&E and IHC staining (P <.001). The sensitivity of the BLN assay compared with pathologic findings classified according to the TNM classification was 95.7% for macrometastases, 60.0% for micrometastases, and 55.6% for isolated tumor cells. CONCLUSIONS: The 2-marker BLN assay performs in a manner that is comparable to, and analyzes more tissue than, routine pathologic examination. Therefore, clinical intraoperative use of the BLN assay for SLNs may result in a reduction in the need for second surgery for ALND. Cancer 2010;116:4450-5.

Application of immunohistochemistry for detection of metastases in sentinel lymph nodes of non-advanced breast cancer patients

“…The authors also noted the possibility of false positive results (4% in their experiments). Funasako et al obtained very similar results for detecting all me-tastases (95.7% sensitivity for metastases larger than 2 mm, 60% for micrometastases and 55.6% for ITC) [12]. Mansel et al reported 88.9% sensitivity using GeneSearch BLN Assay [21].…”

An intra-operative RT-LAMP method allows rapid and reliable detection of sentinel lymph node metastasis in breast cancer patients

“…When only CK19 and MG were included as parameters the sensitivity of the BLN assay decreased from 81.1 % to 73.0 % and 51.4 %, respectively [18]. However, RT-LAMP was reported as more sensitive than the PCR method [23].…”

“…Among these methods, the Food and Drug Administration (FDA) approved breast lymph node (BLN) assay and the fully automated GeneXpert assay are all based quantitative reverse-transcription PCR (QRT-PCR) and can be completed in approximately 30-40 min. Unfortunately, despite their good performance compared to pathological examination [15][16][17][18][19][20][21], the two methods have not been widely applied in clinical practice because the BLN assay was withdrawn from the market [14], and the GeneXpert assay is not commercially available.…”

Le ganglion sentinelle sous anesthésie locale dans le cancer du sein : contre

“…Dans la situation du GS associé au geste mammaire sous AG, le risque de réintervention pour GS positif est de l'ordre de 30 % s'il n'y a pas d'évaluation extemporane du GS, de 15 % si cette évaluation est faite par technique extemporane classique [6] voire bien moindre (nulle ?) avec les techniques d'évaluation moléculaire peropératoire du ganglion qui sont en train de se mettre en place [10].…”

“…. Pour le temps « pathologiste », l'arrivée de machines automatisées installées au bloc opératoire est une solution déjà mise en place aux États-Unis ou au Japon [10]. Le temps anesthésiste épargné est quant à lui plus discutable, peut-on en effet se passer de toutsurveillance anesthésique quand on sait qu'il peut y avoir des réactions anaphylactiques au bleu patenté ou lorsqu'il est nécessaire de compléter l'anesthésie locale ?…”