Comparison Between Early Breast Cancer Patients Who Underwent Sentinel Lymph Node Examination by One-Step Nucleic Acid Amplification and Conventional Pathological Examination in Terms of Breast Cancer Treatment and Survival Outcome
Comparison of Sentinel Node Analysis Methods in Early Breast Cancer
Keywords:
Breast cancer, One-step nucleic acid amplification, Sentinel lymph node biopsy, Survival outcomeAbstract
Background: Sentinel lymph node biopsy (SLNB) is a standard axillary staging for early breast cancer. One-step nucleic acid amplification (OSNA) is a new molecular technique for intraoperative examination to measure the copies of cytokeratin 19 (CK19) mRNA. A higher proportion of micrometastasis detected by OSNA has been reported. However, the impact on treatment planning and survival outcomes is still inconclusive.
Objectives: To compare the adjuvant systemic treatment in the patients who underwent SLNB examination by conventional pathological examination and OSNA assay and survival outcomes between these two groups.
Patients and Methods: A retrospective review of patients with early breast cancer who underwent SLNB from 2014-2018 was performed. Adjuvant systemic treatments were compared between the two groups using Chi-square statistics. The log-rank test analyzed the survival outcome.
Results: There were 109 and 110 patients in the OSNA and conventional groups, respectively. The OSNA group had a higher proportion of positive SLN than the conventional group (40.4% vs. 18.2%; p = 0.004). A higher percentage of the patients in the OSNA group received doxorubicin/cyclophosphamide followed by paclitaxel (43.9% vs. 23.0%, p = 0.041). A higher proportion of the patients in the OSNA group received HER2-targeted therapy (12.8% vs. 3.6%; p = 0.013). There was no difference in axillary recurrence, disease-free survival, or overall survival.
Conclusion: Utilization of the OSNA technique resulted in a higher proportion of positive SLN and led to the escalation of the chemotherapy regimen. However, the impact on survival outcomes could not be demonstrated. The OSNA technique should be applied in selected patients who require immediate ALND after positive SLNs or need a decision to avoid ALND in cases of limited metastasis in SLNs.
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