title: Transcription-reverse transcription concerted reaction and minimal residual disease in axillary sentinel nodes of breast cancer.
abstract: OBJECTIVE
  To investigate the use of transcription-reverse transcription concerted reaction (TRC) to detect axillary lymph node metastases.
  
  
  METHODS
  Metastases in 423 lymph nodes obtained from 50 breast cancer patients were investigated by routine pathological hematoxylin and eosin (H and E) staining and quantitative analysis of carcinoembryonic antigen (CEA) mRNA by TRC. Enhanced pathological studies, serial sectioning and immunohistochemistry were conducted for cases which were negative by routine pathology, but positive by TRC.
  
  
  RESULTS
  Pathological examination identified metastatic disease in 67 lymph nodes. TRC CEA mRNA results were concordant with 89.8% of these cases at a threshold of 100 copies. TRC identified 30 false negative nodes, which was reduced to 15 by excluding node biopsies yielding less than 40 microg total RNA. Twelve nodes were histologically negative for cancer, but positive according to TRC. Serial sectioning and immunohistochemical analysis of these nodes revealed macrometastatic lesions in three, micrometastasis in one, and isolated tumor cells in two.
  
  
  CONCLUSIONS
  TRC for the detection of CEA mRNA may complement routine pathological examination by sentinel lymph node biopsy (SNB) in early breast cancer. We have started an enhanced pathological examination with serial sectioning on all excised sentinel nodes to set the best threshold for the TRC method.
authors.affiliation: Department of General Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan. tishik@urahp.yokohama-cu.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Ishikawa
authors.forename: E
authors.initials: E
authors.lastname: Miyajima
authors.forename: T
authors.initials: T
authors.lastname: Sasaki
authors.forename: M
authors.initials: M
authors.lastname: Tanabe
authors.forename: C
authors.initials: C
authors.lastname: Matsumoto
authors.forename: A
authors.initials: A
authors.lastname: Nozawa
authors.forename: K
authors.initials: K
authors.lastname: Kawachi
authors.forename: Y
authors.initials: Y
authors.lastname: Fukuno
authors.forename: H
authors.initials: H
authors.lastname: Takeda
authors.forename: T
authors.initials: T
authors.lastname: Hayashi
authors.forename: S
authors.initials: S
authors.lastname: Onaka
authors.forename: N
authors.initials: N
authors.lastname: Momiyama
authors.forename: Y
authors.initials: Y
authors.lastname: Ichikawa
authors.forename: K
authors.initials: K
authors.lastname: Inui
authors.forename: H
authors.initials: H
authors.lastname: Shimada
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002272:Carcinoembryonic Antigen / Q000032:analysis; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008875:Middle Aged; D018365:Neoplasm, Residual; D011237:Predictive Value of Tests; D012334:RNA, Neoplasm / Q000032:analysis*; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D013194:Staining and Labeling; D018709:Statistics, Nonparametric
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D012334:RNA, Neoplasm