Open AccessRole of one-step nucleic acid amplification in colorectal cancer lymph node metastases detection
Author(s) -
Francesco Crafa,
Serafino Vanella,
Onofrio A. Catalano,
Kelsey L. Pomykala,
Mario Baiamonte
Publication year - 2022
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v28.i30.4019
Subject(s) - medicine , lymph node , colorectal cancer , micrometastasis , h&e stain , stage (stratigraphy) , cytokeratin , lymphadenectomy , sentinel lymph node , pathology , cancer , oncology , lymphatic system , metastasis , radiology , immunohistochemistry , biology , breast cancer , paleontology
Current histopathological staging procedures in colorectal cancer (CRC) depend on midline division of the lymph nodes (LNs) with one section of hematoxylin and eosin staining. Cancer cells outside this transection line may be missed, which could lead to understaging of Union for International Cancer Control Stage II high-risk patients. The one-step nucleic acid amplification (OSNA) assay has emerged as a rapid molecular diagnostic tool for LN metastases detection. It is a molecular technique that can analyze the entire LN tissue using a reverse-transcriptase loop-mediated isothermal amplification reaction to detect tumor-specific cytokeratin 19 mRNA. Our findings suggest that the OSNA assay has a high diagnostic accuracy in detecting metastatic LNs in CRC and a high negative predictive value. OSNA is a standardized, observer-independent technique, which may lead to more accurate staging. It has been suggested that in stage II CRC, the upstaging can reach 25% and these patients can access postoperative adjuvant chemotherapy. Moreover, intraoperative OSNA sentinel node evaluation may allow early CRC to be treated with organ-preserving surgery, while in more advanced-stage disease, a tailored lymphadenectomy can be performed considering the presence of aberrant lymphatic drainage and skip metastases.