Using one-step nucleic acid amplification (OSNA) for intraoperative detection of lymph node metastasis in breast cancer patients avoids second surgery and accelerates initiation of adjuvant therapy

• Published in: Annals of oncology Vol. 24; no. 9; pp. 2305 - 2309
• Main Authors: Klingler, S., Marchal, F., Rauch, P., Kenouchi, O., Chrétien, A.S., Genin, P., Leroux, A., Merlin, J.L.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-09-2013; Oxford University Press; Elsevier
• Subjects: Antineoplastic agents; Axilla - diagnostic imaging; Axilla - pathology; Axilla - surgery; Biological and medical sciences; breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cancer; Chemotherapy, Adjuvant; CK19 mRNA; Female; Gynecology. Andrology. Obstetrics; Hematologic and hematopoietic diseases; Humans; Immunohistochemistry; intraoperative assay; Intraoperative Care - methods; Intraoperative Period; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Life Sciences; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Mammary gland diseases; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Nucleic Acid Amplification Techniques; OSNA; PCR assay; Pharmacology. Drug treatments; Radiography; Retrospective Studies; RNA, Messenger - genetics; sentinel lymph node; Sentinel Lymph Node Biopsy; Tumors; PCR assay; breast cancer; sentinel lymph node; OSNA; CK19 mRNA; intraoperative assay; Breast disease; Sentinel lymph node; Adjuvant treatment; Malignant lymphadenopathy; Messenger RNA; Surgery; Diagnosis; Initiation; Nucleic acid; Human; Intraoperative; Malignant hemopathy; Breast cancer; Malignant tumor; Polymerase chain reaction; Lymph node metastasis; Mammary gland diseases; Gene amplification; Molecular biology; Detection; Cancer
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdt160

Sentinel lymph node (SLN) analysis is conventionally analyzed using immunohistochemistry and in the case of SLN involvement, justifies a second surgery for axillary lymph node (ALN) resection, thus delaying the initiation of adjuvant therapies.
Three hundred and eighty-one patients with early stage breast cancer (BC) were considered in this retrospective study. SLNs were detected using combined radioisotope and dye detection. SLN involvement was analyzed using routine intraoperative One-Step Nucleic Acid Amplification (OSNA) assay, in 100 patients and compared with the conventional histopathology carried out previously in 281 patients.
Considering positive SLNs as ‘++’ (CK19 mRNA copy number>5000), ‘+’ (250 < CK19 mRNA copy number <5000) and positive by inhibition in the OSNA group and macro-, micrometastases and isolated tumor cells in the histopathology group, no difference in SLN involvement rate was found between the two groups with 29.0% and 29.9% of positive SLNs, respectively. Using OSNA intraoperatively, the mean time to process the SLN was 42 min allowing immediate ALN resection, reduced significantly (P < 0.01) the re-intervention rate (9% versus 39%) and significantly (P < 0.01) accelerated the initiation of adjuvant therapy (6.2 versus 8.4 weeks).
Using OSNA for intraoperative SLN analysis avoids second surgery for ALN resection in most patients and accelerates initiation of adjuvant therapy.