title: Using one-step nucleic acid amplification (OSNA) for intraoperative detection of lymph node metastasis in breast cancer patients avoids second surgery and accelerates initiation of adjuvant therapy.
abstract: BACKGROUND
  Sentinel lymph node (SLN) analysis is conventionally analyzed using immunohistochemistry and in the case of SLN involvement, justifies a second surgery for axillary lymph node (ALN) resection, thus delaying the initiation of adjuvant therapies.
  
  
  METHODS
  Three hundred and eighty-one patients with early stage breast cancer (BC) were considered in this retrospective study. SLNs were detected using combined radioisotope and dye detection. SLN involvement was analyzed using routine intraoperative One-Step Nucleic Acid Amplification (OSNA) assay, in 100 patients and compared with the conventional histopathology carried out previously in 281 patients.
  
  
  RESULTS
  Considering positive SLNs as '++' (CK19 mRNA copy number>5000), '+' (250 < CK19 mRNA copy number <5000) and positive by inhibition in the OSNA group and macro-, micrometastases and isolated tumor cells in the histopathology group, no difference in SLN involvement rate was found between the two groups with 29.0% and 29.9% of positive SLNs, respectively. Using OSNA intraoperatively, the mean time to process the SLN was 42 min allowing immediate ALN resection, reduced significantly (P < 0.01) the re-intervention rate (9% versus 39%) and significantly (P < 0.01) accelerated the initiation of adjuvant therapy (6.2 versus 8.4 weeks).
  
  
  CONCLUSIONS
  Using OSNA for intraoperative SLN analysis avoids second surgery for ALN resection in most patients and accelerates initiation of adjuvant therapy.
authors: Department of Biopathology, Institut de Cancérologie de Lorraine, Avenue de Bourgogne, CS 30519, 54519 Vandoeuvre les Nancy Cedex, France.
authors: S
authors: S
authors: Klingler
authors: F
authors: F
authors: Marchal
authors: P
authors: P
authors: Rauch
authors: O
authors: O
authors: Kenouchi
authors: A S
authors: AS
authors: Chrétien
authors: P
authors: P
authors: Genin
authors: A
authors: A
authors: Leroux
authors: J L
authors: JL
authors: Merlin
mesh_terms: D001365:Axilla / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007430:Intraoperative Care / Q000379:methods*; D007432:Intraoperative Period; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D021141:Nucleic Acid Amplification Techniques; D012333:RNA, Messenger / Q000235:genetics; D011859:Radiography; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy
chemical_list: D012333:RNA, Messenger
keywords: CK19 mRNA; OSNA; PCR assay; breast cancer; intraoperative assay; sentinel lymph node