Micrometastasis in the Sentinel Node in Women With in situ Ductal Carcinoma. False Positives of the OSNA (One-Step Nucleic Acid Amplification) Method?

One-step nucleic acid amplification (OSNA) is an intraoperative technique with a high sensitivity and specificity for sentinel node assessment. The aim of this study was to assess the impact of OSNA on micrometastases detection rates and use of adjuvant chemotherapy. A retrospective review of patients with sentinel node micrometastases over a five-year period was carried out and a comparison of micrometastases detection using OSNA and H&E techniques was made. Out of 1285 patients who underwent sentinel node (SLN) biopsy, 76 patients had micrometastases. Using H&E staining, 36 patients were detected with SLN micrometastases (9/year) in contrast to 40 patients in the OSNA year (40/year) (p<0.0001), demonstrating a fourfold increase with the use of OSNA. In the OSNA group, there was also a proportional increase in Grade III, triple-negative, ER-negative, and HER-2-positive tumours being diagnosed with micrometastases. Also on interactive PREDICT tool, the number of patients with a predicted 10-year survival benefit of more than 3% with adjuvant chemotherapy increased from 52 to 70 percent. OSNA has resulted in an increased detection rate of micrometastases especially in patients with aggressive tumour biology. This increased the number of patients who had a predicted survival benefit from adjuvant chemotherapy.

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Utility of the OSNA assay in sentinel node mapping for early gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.13 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 13-13

Author(s):

Hiroya Takeuchi ◽

Tomohiko Nishi ◽

Rieko Nakamura ◽

Tsunehiro Takahashi ◽

Norihito Wada ◽

...

Keyword(s):

Gastric Cancer ◽

Nucleic Acid ◽

Early Gastric Cancer ◽

Sentinel Node ◽

Histological Examination ◽

Nucleic Acid Amplification ◽

Histopathological Diagnosis ◽

Frozen Sections ◽

One Step ◽

Osna Assay

13 Background: Recent studies on sentinel node (SN) mapping for early gastric cancer have shown acceptable results in terms of detection rate and accuracy to determine lymph node (LN) status. Accurate detection of nodal metastasis including micrometastasis during surgery is indispensable for clinical application of minimized gastrectomy based on SN mapping and biopsy. However, histopathological diagnosis of micrometastasis using frozen sections has to be considered as limitations for intraoperative pathology. We hypothesized that one-step nucleic acid amplification (OSNA) assay may allow the PCR-based intraoperative diagnosis to be applicable to SN mapping for early gastric cancer. Methods: A prospective study of SN mapping using the OSNA (One-step nucleic acid amplification) assay has been conducted for patients with cT1N0M0 gastric cancer at our institution. All SNs and randomly selected non-SNs were examined by routine histopathological diagnosis and the OSNA assay. Results: Histological examination was performed in in 1,732 LNs (286 SNs and 1,446 non-SNs) from 43 patients with cT1N0M0 gastric cancer. We also evaluated 439 LNs (286 SNs and 153 non-SNs) with histological examination and the OSNA assay from the 43 patients. Histological LN metastasis was revealed in 6 (14.0%) of 43 patients. All (100%) of the 6 patients with LN metastasis showed positive SNs by histological examination. The diagnostic accuracy to predict the LN status based on SN concept by histological examination was 100%. The concordance rate between the OSNA assay and the histological examination of paraffin specimens was 0.970 (95 % CI, 0.950–0.984). Discordant results were observed in 13 LNs (3.0 %). Sensitivity and specificity of the OSNA assay compared to the histological examination were 0.636 (95 % CI, 0.407–0.828) and 0.988 (95 % CI, 0.972–0.996), respectively. The OSNA assay to evaluate the SNs status was comparable with intraoperative pathological diagnosis of frozen sections of SNs in terms of concordance rate (0.981), sensitivity (0.800) and specificity (0.995). Conclusions: Our results suggest that the OSNA assay may be a useful tool for the intraoperative detection of metastasis in SNs for patients with early gastric cancer.

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Quantitative expression study of four cytokeratins and p63 in squamous cell carcinoma of the tongue: suitability for sentinel node navigation surgery using one-step nucleic acid amplification

Journal of Clinical Pathology ◽

10.1136/jclinpath-2011-200085 ◽

2011 ◽

Vol 64 (10) ◽

pp. 875-879 ◽

Cited By ~ 10

Author(s):

Kohichi Yamauchi ◽

Yasunori Fujioka ◽

Yasunao Kogashiwa ◽

Naoyuki Kohno

Keyword(s):

Squamous Cell Carcinoma ◽

Nucleic Acid ◽

Sentinel Node ◽

Cell Carcinoma ◽

Squamous Cell ◽

Nucleic Acid Amplification ◽

Navigation Surgery ◽

Sentinel Node Navigation Surgery ◽

One Step ◽

Carcinoma Of The Tongue

AimsSentinel node navigation surgery (SNNS) is currently considered to provide better staging of regional metastasis. For rapid and accurate sentinel lymph node analysis, one-step nucleic acid amplification using cytokeratin 19 (CK19) has been applied, particularly in breast cancer. On the other hand, additional quantitative reverse transcription PCR targets containing cytokeratins have been reported recently in head and neck cancer. In this report, CK19 and p63 were immunohistochemically examined in primary tumours for use as molecular markers and were compared with cytokeratin 903 (CK903), cytokeratin 8/18 (CK8/18) and cytokeratin (AE1/AE3), which are used in diagnostic immunohistochemistry for head and neck squamous cell carcinoma.MethodsThe study reviewed 17 patients with T1/T2, N0 (UICC) oral squamous cell carcinoma of the tongue who were treated surgically at Kyorin University Hospital between 2002 and 2009. The intensity and proportion of tumour cells stained for CK19, CK903, p63, CK8/18 and AE1/AE3 were evaluated.ResultsCK19 and CK8/18 staining in cytoplasm was patchy among carcinoma cells, indicating weak expression. Staining proportion for p63, CK903 and AE1/AE3 was greater than for CK19 and CK8/18, although staining intensity for CK903 was weaker than for p63 and AE1/AE3. The difference in total score between CK19 and CK8/18 staining and p63, CK903 and AE1/AE3 staining was statistically significant (p<0.001). p63 and AE1/AE3 may be better markers than CK903, CK19 and CK8/18.ConclusionsThis suggests that p63 is of clinical utility in SNNS and that CK19 is unsuitable for early tongue carcinoma. Further studies are needed before clinical application of these markers.

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