title: Utility of the GeneSearch breast lymph node assay for the rapid evaluation of sentinel lymph nodes in breast cancer.
abstract: BACKGROUND
  The potential for reducing the need for second surgery for axillary lymph node dissection (ALND) has made the intraoperative evaluation of sentinel lymph nodes (SLNs) attractive. The goal of the current study was to evaluate the clinical application of the breast lymph node (BLN) assay, a real-time reverse transcriptase-polymerase chain reaction assay for SLN metastases, by comparing this test with routine pathologic examination.
  
  
  METHODS
  A total of 117 patients with breast cancer underwent breast surgery with SLN biopsy. Each SLN was cut in half along the plane of the longest dimension. Half of each lymph node was examined by the 2 markers of the BLN assay, mammaglobin and cytokeratin 19, and the other half was examined by hematoxylin and eosin staining (H&E) and immunohistochemical staining (IHC) for pancytokeratins.
  
  
  RESULTS
  A total of 204 SLNs were obtained from 117 patients. H&E staining identified metastases in 31 SLNs (15.2%), and IHC staining detected metastases in 6 SLNs; 40 SLNs from 32 patients were found to be positive for metastasis using the BLN assay. The assay results were correlated with the pathologic diagnoses by H&E and IHC staining (P<.001). The sensitivity of the BLN assay compared with pathologic findings classified according to the TNM classification was 95.7% for macrometastases, 60.0% for micrometastases, and 55.6% for isolated tumor cells.
  
  
  CONCLUSIONS
  The 2-marker BLN assay performs in a manner that is comparable to, and analyzes more tissue than, routine pathologic examination. Therefore, clinical intraoperative use of the BLN assay for SLNs may result in a reduction in the need for second surgery for ALND.
authors.affiliation: Department of Surgical Oncology and Breast and Endocrine Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan. ywr@m3.kufm.kagoshima-u.ac.jp
authors.forename: Yawara
authors.initials: Y
authors.lastname: Funasako
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Uenosono
authors.forename: Munetsugu
authors.initials: M
authors.lastname: Hirata
authors.forename: Takaaki
authors.initials: T
authors.lastname: Arigami
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Yanagita
authors.forename: Hideo
authors.initials: H
authors.lastname: Arima
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Ehi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kijima
authors.forename: Heiji
authors.initials: H
authors.lastname: Yoshinaka
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D011933:Reagent Kits, Diagnostic; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods
chemical_list: D011933:Reagent Kits, Diagnostic