Introduction: The role of sentinel lymph node micrometastases on histopathological analysis is controversial in axillary staging and management in clinically node negative breast cancer. Long-term studies addressing the clinical relevance of occult breast cancer in sentinel lymph nodes based on molecular analysis are lacking. One Step Nucleic Acid Amplification (OSNA), a highly sensitive assay of cytokeratin 19 mRNA, is used intra-operatively for the detection of lymph node macro- and micrometastases in breast cancer.

Aim: The aim of this study is to review the rate of micrometastases and further histopathological NSLN metastases, in our unit following the introduction of OSNA in Guildford.

Methods: Data was collected prospectively from the period of introduction 01/12/2008 to 31/05/2013. All patients eligible for sentinel lymph node biopsy were offered OSNA and operations were performed by the consultant breast surgeons. Presence or absence of micro-metastases depends on the agreed cut-off point on the amplification curve. On detection of micrometastases (+) and positive but inhibited (i+) metastases, a level 1 axillary clearance (ANC) was performed and for a macrometastasis (++), a level 3 ANC was carried out.

Results: 66% of the patients had negative SLN (n = 672) and 34% (n = 336) had positive sentinel lymph nodes who had further axillary surgery. Of these, 45% (n = 152/336) had macrometastases, 40% (n = 136/336) had micrometastases and 15% (48/336) had positive but inhibited results. There was no difference in the patient demographics and tumour characteristics in the various positive SLN groups. In patients with micrometastases, 15% (20/136) had further positive NLSNs and a further 6% (8/136) had >4 overall positive nodes (SLN + NSLN) thus requiring adjuvant supraclavicular/chest wall radiotherapy (p < 0.05). 25% of node positive patients had further NLSN metastases (85/336) and in these patients, the ratio of positive SLN/harvested SLN (+SLN/SLN) is constant at 1:1. This shows the likelihood of further positive NSLNs if all the harvested lymph nodes are positive. This linear trend is present in both micro-and macrometastases, thus correlating with the size and number of NSLN metastases.

Conclusion: Our study reflects the tumour burden of NSLNs based on the molecular analysis of the SLN. OSNA has the potential to accurately identify axillary micrometastases. Micro-metastases are important as some of the patients with micrometastases had overall four positive nodes [SLN + NSLN] (criteria for radiotherapy in the absence of other adverse clinicopathological features). Also, our study highlights certain factors that predict the NSLN metastases, pending validation by further prospective long-term data. This will allow accurate calculation of the axillary tumour burden, particularly in patients with micro-metastases.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.surge.2014.06.001DOI Listing

Publication Analysis

Top Keywords

sentinel lymph
16
lymph node
12
step nucleic
8
nucleic acid
8
acid amplification
8
amplification osna
8
histopathological nsln
8
nsln metastases
8
micrometastases histopathological
8
breast cancer
8

Similar Publications

Objectives: The aim of this prospective study was to assess the association between methylene blue staining pattern and the presence of histologic nodal metastasis in dogs with low-grade mast cell tumour in low-resource settings for the efficient diagnosis of lymphatic spread.

Methods: Dogs with a single, cytologically low-grade mast cell tumour and no documented distant metastases were prospectively included and underwent surgery. Along with primary mast cell tumour removal, intraoperative sentinel lymph node mapping with peritumoral mast cell tumour injection and regional lymph node excision, regardless of whether blue dye was visible in the lymph node, were performed.

View Article and Find Full Text PDF

Patent Blue V (PBV) is extensively used in sentinel lymph node identification in cancer surgery, potentially leading to an increased incidence of hypersensitivity reactions. A retrospective analysis was conducted on patients with suspected PBV hypersensitivity, at our center from 2010 to 2023. Skin prick tests (SPT) were performed on all patients, followed by intradermal tests (IDT) if SPT was negative.

View Article and Find Full Text PDF

Purpose Of Review: This review aims to explore the evolving management strategies for stage III melanoma, focusing on the comparative effectiveness of traditional surgical approaches like complete lymph node dissection (CLND) versus modern adjuvant therapies. It also examines the latest evidence on the efficacy, risks, and complications of these strategies, emphasizing the role of shared decision-making between patients and clinicians.

Recent Findings: Recent clinical trials and meta-analyses, including the MSLT-II and DeCOG-SLT studies, have demonstrated that CLND may not significantly improve survival outcomes in melanoma patients with sentinel lymph node biopsy (SLNB)-positive status.

View Article and Find Full Text PDF

HER2 positive primary breast squamous cell carcinoma with good prognosis: a case report.

AME Case Rep

November 2024

Department of Clinical Laboratory Diagnosis, Shijiazhuang Pingan Hospital, Hebei Medical University, Shijiazhuang, China.

Background: Primary breast squamous cell carcinoma (PBSCC) is a unique histopathological type of breast cancer. The majority of current case reports of PBSCC are triple-negative tumors with poor prognosis. Due to its heterogeneous clinical course, no unified management is achieved.

View Article and Find Full Text PDF

Chronic inflammation in the tumour microenvironment (TME) via Th2-polarisation promotes melanoma progression and metastasis, making it a target for immunotherapy. Interleukin (IL)-4 is considered essential for Th2-polarisation in the TME; however, its source remains unknown. Basophils have been postulated as one of its sources.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!