Fung, V;
Kohlhardt, S;
Vergani, P;
Zardin, GJ;
Williams, NR;
(2017)
Intraoperative prediction of the two axillary lymph node macrometastases threshold in patients with breast cancer using a one‑step nucleic acid cytokeratin‑19 amplification assay.
Molecular and Clinical Oncology
, 7
(5)
pp. 755-762.
10.3892/mco.2017.1404.
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Intraoperative prediction of the two axillary lymph node macrometastases threshold in patients with breast cancer using a one-step nucleic acid cytokeratin-19 amplification assay.pdf - Published Version Download (450kB) | Preview |
Abstract
The aim of the present study was to assess the sensitivity, specificity and practicality of using a one‑step nucleic acid amplification (OSNA) assay during breast cancer staging surgery to predict and discriminate between at least 2 involved nodes and more than 2 involved nodes and facilitate the decision to provide axillary conservation in the presence of a low total axillary node tumour burden. A total of 700 consecutive patients, not treated with neo‑adjuvant chemotherapy, received intraoperative sentinel lymph node (SLN) analysis using OSNA for cT1‑T3 cN0 invasive breast cancer. Patients with at least one macrometastasis on whole‑node SLN analysis underwent axillary lymph node dissection (ALND). The total tumour load (TTL) of the macrometastatic SLN sample was compared with the non‑sentinel lymph node (NSLN) status of the ALND specimen using routine histological assessment. In total, 122/683 patients (17.9%) were found to have an OSNA TTL indicative of macrometastasis. In addition, 45/122 (37%) patients had NSLN metastases on ALND with a total positive lymph node burden exceeding the American College of Surgeons Oncology Group Z0011 trial threshold of two macrometastatic nodes. The TTL negative predictive value was 0.975 [95% confidence interval (CI), 0.962‑0.988]. The area under the curve for the receiver operating characteristic curve was 0.86 (95% CI, 0.81‑0.91), indicating that SLN TTL was associated with the prediction (and partitioning) of total axillary disease burden. OSNA identifies a TTL threshold value where, in the presence of involved SLNs, ALND may be avoided. This technique offers objective confidence in adopting conservative management of the axilla in patients with SLN macrometastases.
| Type: | Article |
|---|---|
| Title: | Intraoperative prediction of the two axillary lymph node macrometastases threshold in patients with breast cancer using a one‑step nucleic acid cytokeratin‑19 amplification assay |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.3892/mco.2017.1404 |
| Publisher version: | http://doi.org/10.3892/mco.2017.1404 |
| Language: | English |
| Additional information: | Copyright: © Fung et al. This is an open access article distributed under the terms of Creative Commons Attribution (https://creativecommons.org/licenses/by-nc-nd/4.0/) License. |
| Keywords: | Breast cancer, sentinel lymph node, axillary lymph node dissection, one‑step nucleic acid amplification assay, total tumour load, cytokeratin‑19 |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1572243 |
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