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Intraoperative sentinel lymph node assessment in breast cancer: a comparison of rapid diagnostic method based on CK 19 mRNA expression and imprint cytology
Author(s) -
Pathmanathan Nirmala,
Renthawa Jasveen,
French James R.,
EdstromElder Elizabeth,
Hall Geoffrey,
Mahajan Hema,
Teh Christina,
Bilous Michael A.
Publication year - 2014
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12668
Subject(s) - medicine , histopathology , cytology , h&e stain , biopsy , sentinel node , sentinel lymph node , breast cancer , lymph node , cytokeratin , pathology , radiology , axilla , micrometastasis , frozen section procedure , lymph , cancer , immunohistochemistry
Background Sentinel lymph node biopsy in breast cancer is a routine technique for staging the axilla. The two most common methods of intraoperative histopathological assessment, imprint cytology and frozen section, are hampered by poor sensitivity and lack standardized methodology. The one‐step nuclei acid amplification ( OSNA ) assay is a rapid quantification of cytokeratin 19 mRNA . This prospective study compared an existing intraoperative imprint cytology protocol with the OSNA system. Methods Of the 110 prospectively recruited patients, 98 met the inclusion criteria with a total of 170 lymph nodes. Intraoperative sentinel nodes were serially sectioned and imprints made of each cut surface for cytological assessment. Alternate slices were submitted for OSNA while the remaining slices were for final histopathological evaluation with six hematoxylin and eosin levels and one AE 1/ AE 3 immunoperoxidase stain of each slice. Results On histopathological analysis, 24.5% of patients (16.5% of nodes) had sentinel node metastases and 3.1% (2.4%) had isolated tumour cells. With isolated tumour cells cases taken as negative, the sensitivity of imprint cytology and OSNA compared with histopathology were 66.7% on patient basis (71.4% on per‐node basis) and 95.8% (89.3%), respectively. One of 22 patients with macrometastases and two of three micrometastases were designated negative while five false‐positive nodes were identified with OSNA , likely due to tissue allocation bias. Conclusion The OSNA assay is highly sensitive in comparison with imprint cytology and may be used effectively in the intraoperative setting. Clinical follow‐up studies are warranted to further assess its use in routine practice.