Transcription-reverse transcription concerted reaction and minimal residual disease in axillary sentinel nodes of breast cancer.
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.
Ishikawa
T
T
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
Miyajima
E
E
Sasaki
T
T
Tanabe
M
M
Matsumoto
C
C
Nozawa
A
A
Kawachi
K
K
Fukuno
Y
Y
Takeda
H
H
Hayashi
T
T
Onaka
S
S
Momiyama
N
N
Ichikawa
Y
Y
Inui
K
K
Shimada
H
H
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
D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D012334:RNA, Neoplasm