title: Sentinel lymph node biopsy in breast cancer: the role of micrometastasis.
abstract: Intraoperative sentinel lymph node biopsy is widely used in patients with early-stage breast cancer for staging the axilla. The conventional analysis of the SLN has classically been performed by frozen section or touch imprint with a rapid H&E (hematoxylin and eosin) staining. Because of the risk of false-negative results, it has been replaced by the one-step acid amplification (OSNA) assay, a molecular diagnostic assay for the detection of cytokeratin 19 mRNA expression. Due to the controversial for the use of OSNA to evaluate the SLN because of its cost-effective and the lack of consensus to perform or avoid a lymphadenectomy when there is micrometastasis, we analyze 410 patients subjected to SLN biopsy in Hospital Puerta de Hierro, Madrid (Spain). Of the total of nodes, 223 (54.4 %) were processed throughout frozen-section examination and imprint cytology and 187 (45.6 %) throughout OSNA. The specificity of the frozen-section histological examination was of 100 %, with a sensitivity of 83.33 % (95 % CI 73.07-93.60). Of the 40 patients with definitive micrometastasis in the SLN, axillary dissection was performed in 90 % of the patients, with subsequent positive affectation in four of them (11.11 %). Based on our result and taking into account that 10 % of the lymphadenectomy performed after micrometastasis are positive, we do not believe that lymphadenectomy should be avoided after N(mi+) is detected in a SLN.
authors.affiliation: Medical Oncology Service, Hospital Universitario Puerta de Hierro Majadahonda, Calle Manuel de Falla, 1, 28222, Madrid, Spain, davidperezc@hotmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Pérez-Callejo
authors.forename: Fernando
authors.initials: F
authors.lastname: Franco
authors.forename: Beatriz
authors.initials: B
authors.lastname: Núñez
authors.forename: Carmen
authors.initials: C
authors.lastname: González-Lois
authors.forename: Blanca
authors.initials: B
authors.lastname: Cantos
authors.forename: Mariano
authors.initials: M
authors.lastname: Provencio
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D003581:Cytodiagnosis / Q000379:methods*; D005260:Female; D006801:Humans; D053539:Keratin-19 / Q000032:analysis; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008875:Middle Aged; D061206:Neoplasm Micrometastasis / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods; D021141:Nucleic Acid Amplification Techniques; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy
chemical_list: D053539:Keratin-19