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1.
Arch Gynecol Obstet ; 306(6): 2123-2131, 2022 12.
Article in English | MEDLINE | ID: mdl-35503378

ABSTRACT

PURPOSE: Completion axillary lymph node dissection (cALND) can currently be avoided in those patients with a low tumor load (LTL) and/or a low-risk profile that tested with positive sentinel lymph node biopsy (SLNB). Our objective is to identify prognostic factors that significantly influence axillary lymph node involvement to identify patients who could benefit from surgery without axillary lymphadenectomy. METHODS: This is an observational retrospective study of consecutive patients diagnosed and operated of breast cancer between 2000 and 2014 at University Hospital La Ribera (UHR). RESULTS: The size of the sample was 1641 patients, from which 1174 underwent SLNB. In the multivariate analysis, we objectify a raise of risk of positive sentinel lymph node (SLN) up to 5.2% for every millimeter of increase. The risk of positive SLNB when showing lymphovascular invasion seems to be 2.80 times greater but becomes lower when SLN involvement appears in luminal A, luminal B and triple-negative types, regarding HER2. In case of triple negatives, the difference is statistically significant. 16.7% present affected additional lymph nodes. The proportion of patients with affected additional lymph nodes increase dramatically above OSNA values of 12,000 copies/µl of CK19 mRNA and it depends on tumor size and lymphovascular infiltration. CONCLUSIONS: Tumors smaller than 5 cm whose OSNA SLNB analysis is less than 12,000 copies/µl of CK19 mRNA have a low chance to develop additional affected lymph nodes, thus cALND can be avoided.


Subject(s)
Breast Neoplasms , Sentinel Lymph Node Biopsy , Humans , Female , Lymphatic Metastasis/pathology , Breast Neoplasms/surgery , Breast Neoplasms/pathology , Retrospective Studies , Lymph Node Excision , Axilla/pathology , Lymph Nodes/surgery , Lymph Nodes/pathology , RNA, Messenger/analysis
2.
Diagn Mol Pathol ; 21(2): 69-76, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22555089

ABSTRACT

In breast cancer, the number of lymph node metastases is the strongest predictor of outcome. However, histopathology may underestimate the frequency of metastasis. Here we compare automated molecular detection of cytokeratin 19 mRNA by one-step nucleic acid amplification (OSNA) with histopathology of single tissue sections for the staging of axillary lymph nodes in patients with breast cancer. Axillary lymph nodes were collected from 55 patients with primary breast cancer and sentinel lymph node (SLN) metastases. The central 1-mm portion of each node was processed for hematoxylin-eosin staining, and the remaining tissue was analyzed by OSNA. According to OSNA, histopathology misclassified 41.8% of patients as negative for axillary node metastasis (P=0.007). Of the individual nodes considered negative by histopathology, 4.5% contained micrometastases and 2.5% contained macrometastases according to OSNA. Furthermore, 80% of micrometastases identified by histopathology were reclassified as macrometastases by OSNA. Histopathology failed to identify 81.1% of nodes shown to contain metastasis by OSNA. However, OSNA yielded no false-negative results. On the basis of OSNA results, 3 patients were reclassified to a higher pathologic stage. The number of SLN and non-SLN metastases was unrelated according to OSNA (P=0.891). These results show that, compared with molecular detection, histopathology of single tissue sections significantly underestimates the frequency of axillary node metastases. We discuss the implications of these findings in light of current recommendations on the staging of breast cancer.


Subject(s)
Biomarkers, Tumor/genetics , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/secondary , Keratin-19/genetics , Lymph Nodes/pathology , Adult , Aged , Aged, 80 and over , Axilla , Biomarkers, Tumor/metabolism , Breast Neoplasms/metabolism , Carcinoma, Ductal, Breast/metabolism , Female , Humans , Keratin-19/metabolism , Lymphatic Metastasis , Middle Aged , Molecular Diagnostic Techniques , Neoplasm Staging , Nucleic Acid Amplification Techniques , RNA, Messenger/genetics , RNA, Messenger/metabolism , Transcription, Genetic , Young Adult
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