title: Sentinel and nonsentinel lymph node assessment using a combination of one-step nucleic acid amplification and conventional histological examination.
abstract: BACKGROUND
  Clinical significance of intraoperative sentinel lymph node (SLN) metastases detection using one-step nucleic acid amplification (OSNA) has not been thoroughly investigated. The aim of this study was to assess the usefulness of using a combination of OSNA and conventional histological examinations.
  
  
  METHODS
  We included 772 consecutive patients with clinical node-negative cTis-cT3 primary breast cancer who underwent SLN biopsy with intraoperative OSNA and multi-section histological examination at our institution. We estimated the concordance rate and compared SLN metastases detection rates between the two methods. We also compared non-SLN metastasis detection rate between patients who tested positive in OSNA and those who tested positive in histology.
  
  
  RESULTS
  Among 772 patients, SLN metastases were intraoperatively detected in 211 (26.4%) by either OSNA or histology, in 168 (21.8%) by OSNA, and in 150 (19.4%) by histology. The concordance rate between OSNA and histological examination was 89.2%, but only 123 (58.8%) patients tested positive in both OSNA and histology; 45 were positive in OSNA only and 43 were positive in histology only. SLN status as per both OSNA and histology was significantly correlated with the presence of non-SLN metastases and multivariate analysis-identified independent predictive factors of non-SLN metastases.
  
  
  CONCLUSIONS
  Intraoperative SLN metastases detection may be more accurate with a combination of OSNA and histological examination than with OSNA or histological examination alone. By using both methods, we can reduce the risk of false negative rate in SLN biopsy, and may prevent physicians from overlooking patients with non-SLN metastases.
authors.affiliation: Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan. Electronic address: kjimbo@ncc.go.jp.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Jimbo
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Junko
authors.initials: J
authors.lastname: Suzuki
authors.forename: Sota
authors.initials: S
authors.lastname: Asaga
authors.forename: Takashi
authors.initials: T
authors.lastname: Hojo
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yoshida
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tsuda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000235:genetics / Q000556:secondary*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000235:genetics / Q000556:secondary*; D004273:DNA, Neoplasm / Q000032:analysis*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000737:chemistry* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D021141:Nucleic Acid Amplification Techniques; D021701:Sentinel Lymph Node Biopsy
chemical_list: D004273:DNA, Neoplasm
keywords: Breast; Lymph nodes; Nucleic acid amplification; OSNA; Sentinel