Abstract
Aims
We aimed to determine the effectiveness of CK19 mRNA copy number and tumour related
factors in predicting non-sentinel axillary nodal involvement, in order to facilitate
the formulation of local treatment guidelines for axillary clearance (ANC) following
intra-operative analysis of the sentinel node biopsy (SNB) using one-step nucleic
acid amplification (OSNA).
Methods
Patients due to have (SNB) at our institution for breast cancer as well as patients
with high grade ductal carcinoma in situ with pre-operative negative assessment of
the axilla were included. Alternate slices of each node were sent for assessment by
either OSNA or histopathology. Immediate ANC was performed if OSNA was positive. The
CK19 mRNA nodal copy number, the total tumour load (TTL) measured by summation of
mRNA copy numbers of all positive nodes, the nodal status at ANC and tumour characteristics
for each patient were recorded. A model of risk probability was constructed using
TTL and tumour related factors.
Results
664 nodes were analysed from 425 patients who had SNB performed between 2011 and 2014.
ANC was performed on 105 of these patients. The concordance between OSNA and histology
was 91.4% and negative predictive value (NPV) was 97%.
TTL (p = 0.003) and LVI (p = 0.04) were identified as risk factors for non-sentinel
nodal involvement. The risk probability model identified all patients with pN2 disease
for ANC.
Conclusion
In the future a decision to perform ANC will be based on a risk stratification model
based on TTL and tumour related factors.
Keywords
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Article info
Publication history
Published online: March 01, 2016
Accepted:
February 12,
2016
Footnotes
☆The study was partly presented as abstract (poster) in the ASCO breast cancer symposium in San Francisco, California, USA in September 25 2015.
Identification
Copyright
© 2016 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
