Efficacy of Intraoperative One-step Nucleic Acid Amplification Assay for Detection of Breast Cancer Metastases in Sentinel Lymph Node
Keywords:
Breast cancer, nucleic acid amplification assay, sentinel nodeAbstract
Background: Accurate intraoperative diagnosis of sentinel lymph node (SLN) metastases enables the selectionof patients for axillary lymph node dissections during the same operation, reducing the need for a second operation.
To find out whether the one-step nucleic acid amplification (OSNA) assay (Sysmex®) has potential for intraoperative
alternative for SLN evaluation, we evaluated the efficacy of OSNA in comparison with frozen section and permanent
histological findings. Turn-around time of intraoperative OSNA assay was also considered.
Materials and Methods: In total, 111 SLN samples from 62 patients with early stage breast cancers were analyzed.
Each SLN was cut into 2-mm sections. Alternate sections were subjected to OSNA assay and histopathological
evaluation. Binomial distribution analysis with 95% confidence interval (95%CI) was used for all diagnostic value
analysis.
Results: The sensitivity and specificity of the OSNA compared with permanent section before discordant case
analyses was 84.6% (95%CI, 57.8%-95.7%) and 91.8% (95%CI, 84.7%-95.8%) respectively. Sensitivity and specificity
after discordant case analysis were 85.7% (95% CI, 60.0%-96.0%), 92.8% (95% CI, 85.8%-96.5%) and the accuracy was
91.9% (95% CI, 85.3%-95.7%). Turn-around time for OSNA assay was approximately 40 minutes.
Conclusions: The OSNA assay was proven to have high accuracy and reliability for evaluation of lymph node
metastases in breast cancer patients with acceptable processing time. The assay may be used as an alternate method
of frozen section especially in centers lacking of experienced pathologists.
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HD, et al. Multicentre evaluation of intraoperative molecular
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Akiyama F, et al. One-step nucleic acid amplification for
intraoperative detection of lymph node metastasis in breast
cancer patients. Clin Cancer Res 2007;13:4807-16.
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Garcia-Garcia J, Pastor-Pons E, Chamorro-Santos CE, et al.
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node metastases as an alternative to conventional
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prevalence for 27 sites in the adult population in 2008. Int J
Cancer 2013;132:1133-45.
2. Lumachi F, Marino F, Zanella S, Chiara GB, Basso SM. Touch
Imprint Cytology and Frozen-section Analysis for Intraoperative
Evaluation of Sentinel Nodes in Early Breast Cancer. Anticancer
Res 2012;32:3523-6.
3. van de Vrande S, Meijer J, Rijnders A, Klinkenbijl JH. The value
of intraoperative frozen section examination of sentinel lymph
nodes in breast cancer. Eur J Surg Oncol 2009;35:276-80.
4. Krishnamurthy S, Meric-Bernstam F, Lucci A, Hwang RF, Kuerer
HM, Babiera G, et al. A prospective study comparing touch
imprint cytology, frozen section analysis, and rapid cytokeratin
immunostain for intraoperative evaluation of axillary sentinel
lymph nodes in breast cancer. Cancer 2009;115:1555-62.
5. Backus J, Laughlin T, Wang Y, Belly R, White R, Baden J, et al.
Identification and characterization of optimal gene expression
markers for detection of breast cancer metastasis. J Mol
Diagn 2005;7:327-36.
6. Blumencranz PW, Pieretti M, Allen KG, Blumencranz LE.
Molecular analysis of breast sentinel lymph nodes. Surg Oncol
Clin N Am 2011;20:467-85.
7. Notomi T, Okayama H, Masubuchi H, Yonekawa T, Watanabe
K, Amino N, et al. Loop-mediated isothermal amplification of
DNA. Nucleic Acids Res 2000;28:E63.
8. Visser M, Jiwa M, Horstman A, Brink AA, Pol RP, van Diest P, et
al. Intra-operative rapid diagnostic method based on CK19
mRNA expression for the detection of lymph node metastases
in breast cancer. Int J Cancer 2008 Jun 1;122:2562-7.
9. Tamaki Y, Akiyama F, Iwase T, Kaneko T, Tsuda H, Sato K, et al.
Molecular detection of lymph node metastases in breast
cancer patients: results of a multicenter trial using the onestep
nucleic acid amplification assay. Clin Cancer Res
2009;15:2879-84.
10. Schem C, Maass N, Bauerschlag DO, Carstensen MH, Loning
T, Roder C, et al. One-step nucleic acid amplification-a
molecular method for the detection of lymph node metastases
in breast cancer patients; results of the German study group.
Virchows Arch 2009;454:203-10.
11. Bernet L, Cano R, Martinez M, Duenas B, Matias-Guiu X, Morell
L, et al. Diagnosis of the sentinel lymph node in breast cancer:
a reproducible molecular method: a multicentric Spanish
study. Histopathology 2011;58:863-9.
12. Snook KL, Layer GT, Jackson PA, de Vries CS, Shousha S, Sinnett
HD, et al. Multicentre evaluation of intraoperative molecular
analysis of sentinel lymph nodes in breast carcinoma. Br J Surg
2011;98:527-35.
13. Tsujimoto M, Nakabayashi K, Yoshidome K, Kaneko T, Iwase T,
Akiyama F, et al. One-step nucleic acid amplification for
intraoperative detection of lymph node metastasis in breast
cancer patients. Clin Cancer Res 2007;13:4807-16.
14. Rebollo-Aguirre AC, Gallego-Peinado M, Menjon-Beltran S,
Garcia-Garcia J, Pastor-Pons E, Chamorro-Santos CE, et al.
Sentinel lymph node biopsy in patients with operable breast
cancer treated with neoadjuvant chemotherapy. Rev Esp
Med Nucl Imagen Mol 2013;32:240-5.
15. Osako T, Iwase T, Kimura K, Yamashita K, Horii R, Yanagisawa
A, et al. Intraoperative molecular assay for sentinel lymph
node metastases in early stage breast cancer: A comparative
analysis between one-step nucleic acid amplification whole
node assay and routine frozen section histology. Cancer
2011;117:4365-74.
16. Guillen-Paredes MP, Carrasco-Gonzalez L, Chaves-Benito A,
Campillo-Soto A, Carrillo A, Aguayo-Albasini JL. One-step
nucleic acid amplification (OSNA) assay for sentinel lymph
node metastases as an alternative to conventional
postoperative histology in breast cancer: A cost-benefit
analysis. Cir Esp 2011;89:456-62.
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Published
2014-06-30
How to Cite
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Chaisrisawadisuk S, Kummalue T, Chuangsuwanich T, Warnnissorn M, O-charoenrat P. Efficacy of Intraoperative One-step Nucleic Acid Amplification Assay for Detection of Breast Cancer Metastases in Sentinel Lymph Node. Thai J Surg [Internet]. 2014 Jun. 30 [cited 2024 Jul. 18];35(2). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/226393
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