title: Total tumor load assessed by one-step nucleic acid amplification assay as an intraoperative predictor for non-sentinel lymph node metastasis in breast cancer.
abstract: BACKGROUND
  This study aimed to determine the relationship between CK19 mRNA copy number in sentinel lymph nodes (SLN) assessed by one-step nucleic acid amplification (OSNA) technique, and non-sentinel lymph nodes (NSLN) metastization in invasive breast cancer. A model using total tumor load (TTL) obtained by OSNA technique was also constructed to evaluate its predictability.
  
  
  METHODS
  We conducted an observational retrospective study including 598 patients with clinically T1-T3 and node negative invasive breast cancer. Of the 88 patients with positive SLN, 58 patients fulfill the inclusion criteria.
  
  
  RESULTS
  In the analyzed group 25.86% had at least one positive NSLN in axillary lymph node dissection. Univariate analysis showed that tumor size, TTL and number of SLN macrometastases were predictive factors for NSLN metastases. In multivariate analysis just the TTL was predictive for positive NSLN (OR 2.67; 95% CI 1.06-6.70; P = 0.036). The ROC curve for the model using TTL alone was obtained and an AUC of 0.805 (95% CI 0.69-0.92) was achieved. For TTL >1.9 × 105copies/μL we got 73.3% sensitivity, 74.4% specificity and 88.9% negative predictive value to predict NSLN metastases.
  
  
  CONCLUSIONS
  When using OSNA technique to evaluate SLN, NSLN metastases can be predicted intraoperatively. This prediction tool could help in decision for axillary lymph node dissection.
authors.affiliation: Department of Surgery, Centro Hospitalar Lisboa Central, Portugal. Electronic address: celso.nabais@gmail.com.
authors.forename: Celso
authors.initials: C
authors.lastname: Nabais
authors.affiliation: Department of Surgery, Centro Hospitalar Lisboa Central, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Figueiredo
authors.affiliation: Department of Surgery, Centro Hospitalar Lisboa Central, Portugal.
authors.forename: Paulina
authors.initials: P
authors.lastname: Lopes
authors.affiliation: Department of Pathology, Centro Hospitalar Lisboa Central, Portugal.
authors.forename: Manuela
authors.initials: M
authors.lastname: Martins
authors.affiliation: Department of Surgery, Centro Hospitalar Lisboa Central, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Araújo
mesh_terms: D000368:Aged; D001365:Axilla; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D053539:Keratin-19 / Q000235:genetics; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D011237:Predictive Value of Tests; D012333:RNA, Messenger / Q000032:analysis; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D047368:Tumor Burden / Q000235:genetics*
chemical_list: D053539:Keratin-19; D012333:RNA, Messenger
keywords: Axillary lymph node dissection; Breast cancer; Non-sentinel lymph node metastasis; One-step nucleic acid amplification; Sentinel lymph node; Total tumor load