title: Prediction of non-sentinel lymph node metastasis in early breast cancer by assessing total tumoral load in the sentinel lymph node by molecular assay.
abstract: BACKGROUND
  The one-step nucleic acid amplification (OSNA) is a molecular procedure that yields a semiquantitative result for detection of nodal metastasis. Size of metastasis in the sentinel lymph node (SLN) by conventional histology has been described as a predictive factor for additional axillary metastasis. The objective of this study is to quantify intraoperatively the total tumoral load (TTL) in the positive SLNs assessed by OSNA and to determine whether this TTL predicts non-SLN metastasis in patients with clinically node negative early stage breast cancer.
  
  
  METHODS
  306 patients with cT1-3N0 invasive breast cancer who had undergone intraoperative SLN evaluation by OSNA were included. TTL was defined as the addition of CK19 mRNA copies of each positive SLN (copies/μL).
  
  
  RESULTS
  TTL was a predictive factor of additional non-SLN metastasis in the complete axillary lymph node dissection (cALND) (OR, 1.67; 95% CI, 1.18-2.35). In the multivariate analysis, the TTL was a predictor of non-SLN metastasis in HR positive patients (OR, 1.69; 95% CI, 1.19-2.41). In our cohort of patients, with a TTL ≤1.2 × 10(5) copies/μL, there was a specificity of 85.3% and negative predictive value (NPV) of 80%. If we consider only the HR positive patients, with a TTL ≤5 × 10(5) copies/μL there was a specificity of 86.7% and NPV of 83.7%.
  
  
  CONCLUSIONS
  TTL assessed by OSNA assay predicts for additional non-SLN metastasis and this intraoperative tool can help guiding decisions on performing a cALND in breast cancer patients.
authors.affiliation: Breast Surgical Unit, Breast Cancer Center, Department of Gynecology, Hospital Universitario Vall d'Hebron, Barcelona, Spain. maespino@vhebron.net
authors.forename: M
authors.initials: M
authors.lastname: Espinosa-Bravo
authors.forename: I
authors.initials: I
authors.lastname: Sansano
authors.forename: S
authors.initials: S
authors.lastname: Pérez-Hoyos
authors.forename: M
authors.initials: M
authors.lastname: Ramos
authors.forename: M
authors.initials: M
authors.lastname: Sancho
authors.forename: J
authors.initials: J
authors.lastname: Xercavins
authors.forename: I T
authors.initials: IT
authors.lastname: Rubio
authors.forename: V
authors.initials: V
authors.lastname: Peg
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012333:RNA, Messenger / Q000032:analysis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D047368:Tumor Burden
chemical_list: D012333:RNA, Messenger