title: Efficacy of reverse transcriptase-polymerase chain reaction screening for micrometastic disease in axillary lymph nodes of breast cancer patients.
abstract: Pathologic examination of axillary lymph nodes (ALNs) may miss micrometastases in 30 per cent of breast cancer patients. We have developed a multimarker reverse transcriptase-polymerase chain reaction (RT-PCR)-based screening method that detects histopathologically positive ALNs with a 5 per cent false-negative rate. The purpose of this study was to compare this RT-PCR methodology with histopathology with regard to sensitivity and cost. Pathologically negative ALNs from 35 breast cancer patients were re-evaluated by a single pathologist in a blinded fashion using serial sectioning with immunohistochemical staining. Histopathologic results were then compared with those of RT-PCR. Cost analysis was performed based on standard charges for these methods. RT-PCR identified micrometastases in 14 of 35 pathologically negative nodes. Serial sectioning and immunohistochemical staining identified micrometastases in two cases, with RT-PCR positive for one of these. The charge per specimen for performing routine histopathologic examination was $380, serial sectioning and immunohistochemical staining $787, and RT-PCR $125. RT-PCR appears to be more sensitive at detecting ALN micrometastasis than histopathologic examination even with serial sectioning and immunohistochemical staining. If micrometastatic breast cancer detected by RT-PCR proves to be clinically relevant, it could be a more effective screening methodology with significant cost savings as compared to currently available pathologic examinations.
authors.affiliation: Department of Surgery (Section of Surgical Oncology), Hollings Cancer Center, Medical University of South Carolina, Charleston 29425, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Lockett
authors.forename: J S
authors.initials: JS
authors.lastname: Metcalf
authors.forename: P L
authors.initials: PL
authors.lastname: Baron
authors.forename: P H
authors.initials: PH
authors.lastname: O'Brien
authors.forename: B M
authors.initials: BM
authors.lastname: Elliott
authors.forename: J G
authors.initials: JG
authors.lastname: Robison
authors.forename: D J
authors.initials: DJ
authors.lastname: Cole
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy / Q000191:economics; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018567:Breast Neoplasms, Male / Q000473:pathology / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007633:Keratins / Q000032:analysis; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D016133:Polymerase Chain Reaction / Q000191:economics; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D007633:Keratins