title: Intraoperative qRT-PCR for detection of lymph node metastasis in head and neck cancer.
abstract: OBJECTIVE
  Sentinel node biopsy (SNB) has been shown to accurately stage the regional lymphatics in oral carcinoma. However, intraoperative pathology is only moderately sensitive and final pathology takes several days to complete. The purpose of this study was to develop a rapid, automated, and quantitative real-time PCR (qRT-PCR) assay that can match final pathology in an intraoperative time frame.
  
  
  METHODS
  Four hundred forty-eight grossly tumor-negative lymph nodes were evaluated for expression of 3 markers [PVA (pemphigus vulgaris antigen), PTHrP (parathyroid hormone-related protein), and TACSTD1 (tumor-associated calcium signal transducer 1)]. Conformity of metastasis detection by qRT-PCR was determined using hematoxylin and eosin and immunohistochemistry staining as the gold standard. PVA and TACSTD1 were then multiplexed with β-glucuronidase to develop a rapid, automated single-tube qRT-PCR assay using the Cepheid GeneXpert system. This assay was used to analyze 103 lymph nodes in an intraoperative time frame.
  
  
  RESULTS
  Four hundred forty-two nodes produced an informative result for both qRT-PCR and pathologic examination. Concordance of qRT-PCR for individual markers with final pathology ranged from 93% to 98%. The best marker combination was TACSTD1 and PVA. A rapid, multiplex assay for TACSTD1 and PVA was developed on the Cepheid GeneXpert and demonstrated an excellent reproducibility and linearity. Analysis of 103 lymph nodes demonstrated 94.2% accuracy of this assay for identifying positive and negative nodes. The average time for each assay to yield results was 35 minutes.
  
  
  CONCLUSIONS
  A rapid, automated qRT-PCR assay can detect lymph node metastasis in head and neck cancer with high accuracy compared to pathologic analysis and may be more accurate than intraoperative pathology. Combined, SNB and rapid qRT-PCR could more appropriately guide surgical treatment of patients with head and neck cancer.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. ferrisrl@upmc.edu
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ferris
authors.forename: Liqiang
authors.initials: L
authors.lastname: Xi
authors.forename: Raja R
authors.initials: RR
authors.lastname: Seethala
authors.forename: Jon
authors.initials: J
authors.lastname: Chan
authors.forename: Shaun
authors.initials: S
authors.lastname: Desai
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hoch
authors.forename: William
authors.initials: W
authors.lastname: Gooding
authors.forename: Tony E
authors.initials: TE
authors.lastname: Godfrey
mesh_terms: D000951:Antigens, Neoplasm / Q000235:genetics / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000235:genetics; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D015815:Cell Adhesion Molecules / Q000235:genetics / Q000378:metabolism; D051184:Desmoglein 3 / Q000235:genetics / Q000378:metabolism; D000071858:Epithelial Cell Adhesion Molecule; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008198:Lymph Nodes / Q000378:metabolism; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D044162:Parathyroid Hormone-Related Protein / Q000235:genetics / Q000378:metabolism; D012372:ROC Curve; D020133:Reverse Transcriptase Polymerase Chain Reaction; D021701:Sentinel Lymph Node Biopsy
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D015815:Cell Adhesion Molecules; C071894:DSG3 protein, human; D051184:Desmoglein 3; C499379:EPCAM protein, human; D000071858:Epithelial Cell Adhesion Molecule; D044162:Parathyroid Hormone-Related Protein