Martin Espinosa-Bravo1, Joaquin Navarro-Cecilia2, Manuel Ramos Boyero3, Sebastian Diaz-Botero4, Basilio Dueñas Rodríguez5, Carolina Luque López6, Teresa Ramos Grande7, Ricardo Ruano Perez8, Vicente Peg9, Isabel T Rubio10. 1. Breast Surgical Unit, Breast Cancer Center, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain. Electronic address: maespino@vhebron.net. 2. Breast Surgery Unit, Department of Surgery, Hospital Complex of Jaén, Av. del Ejército Español 10, 23007 Jaén, Spain. Electronic address: dr.jnavarro@hotmail.com. 3. Department of Surgery, Breast Surgery Unit, Salamanca University Hospital, Paseo San Vicente 58-182, 37007 Salamanca, Spain. Electronic address: mramos@usal.es. 4. Breast Surgical Unit, Breast Cancer Center, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain. Electronic address: sdiazmd@gmail.com. 5. Breast Surgery Unit, Department of Surgery, Hospital Complex of Jaén, Av. del Ejército Español 10, 23007 Jaén, Spain. Electronic address: bdr@quesadasolidaria.org. 6. Department of Surgery, Hospital Complex of Jaén, Av. del Ejército Español 10, 23007 Jaén, Spain. Electronic address: caluque@gmail.com. 7. Department of Surgery, Breast Surgery Unit, Salamanca University Hospital, Paseo San Vicente 58-182, 37007 Salamanca, Spain. Electronic address: tramos@usal.es. 8. Breast Oncology Unit, Salamanca University Hospital, Paseo San Vicente 58-182, 37007 Salamanca, Spain. Electronic address: rruanoperez@gmail.com. 9. Department of Pathology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain. Electronic address: vpeg@vhebron.net. 10. Breast Surgical Unit, Breast Cancer Center, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain. Electronic address: irubio@vhio.net.
Abstract
PURPOSE: Sentinel lymph node (SLN) biopsy has been shown to be both accurate and feasible for women who receive neoadjuvant chemotherapy (NAC). Intraoperative assessment of SLN by frozen sections can produce false negative results. The aim of this study was to compare two different techniques of intraoperative assessment of SLN in breast cancer patients treated with NAC: frozen section (FS) and molecular assay (OSNA). METHODS: A multicenter cohort of 320 consecutive breast cancer patients treated with NAC between 2010 and 2014 was analyzed. FS was performed intraoperatively in 166 patients (H&E cohort) and OSNA in 154 patients (OSNA cohort). RESULTS: A mean of 2.15 SLNs by FS and 1.22 SLNs by OSNA was assessed (p = 0.03). SLN metastasis was found in 44 patients (26.5%) by FS and in 48 (31.2%) by OSNA (p = 0.4). There was no statistical significance in rates of macrometastasis (75%), micrometastasis (20.5%) or ITCs (4.5%) when assessed by FS compared to OSNA (52.3%, 36.3% and 11.4%, respectively) (p = 0.06). There were 10 patients in the H&E cohort with positive-SLN in the definitive pathology assessment with negative intraoperative FS. When OSNA and definitive pathology were compared, there were no differences in rates of macrometastasis (61.1%), micrometastasis (33.3%) nor ITCs (5.6%) (p = 0.5). Fifty-four patients in the H&E cohort and 44 in the OSNA cohort had ALND after positive-SLNs. ALND was performed in a second surgery in 10 patients (18.5%) in the H&E cohort for intraoperative FS false negative results, 90% being micrometastasis. 42 out of 44 patients (95.5%) in the OSNA cohort had an ALND in the same surgery (p = 0.03). CONCLUSIONS: OSNA assay detects SLNs metastases as accurately as conventional pathology in the NAC setting. Intraoperative definitive assessment of the SLN by OSNA reduces the need for a second surgery for ALND in 18.5% of breast cancer patients with a positive-SLN after NAC.
PURPOSE: Sentinel lymph node (SLN) biopsy has been shown to be both accurate and feasible for women who receive neoadjuvant chemotherapy (NAC). Intraoperative assessment of SLN by frozen sections can produce false negative results. The aim of this study was to compare two different techniques of intraoperative assessment of SLN in breast cancerpatients treated with NAC: frozen section (FS) and molecular assay (OSNA). METHODS: A multicenter cohort of 320 consecutive breast cancerpatients treated with NAC between 2010 and 2014 was analyzed. FS was performed intraoperatively in 166 patients (H&E cohort) and OSNA in 154 patients (OSNA cohort). RESULTS: A mean of 2.15 SLNs by FS and 1.22 SLNs by OSNA was assessed (p = 0.03). SLN metastasis was found in 44 patients (26.5%) by FS and in 48 (31.2%) by OSNA (p = 0.4). There was no statistical significance in rates of macrometastasis (75%), micrometastasis (20.5%) or ITCs (4.5%) when assessed by FS compared to OSNA (52.3%, 36.3% and 11.4%, respectively) (p = 0.06). There were 10 patients in the H&E cohort with positive-SLN in the definitive pathology assessment with negative intraoperative FS. When OSNA and definitive pathology were compared, there were no differences in rates of macrometastasis (61.1%), micrometastasis (33.3%) nor ITCs (5.6%) (p = 0.5). Fifty-four patients in the H&E cohort and 44 in the OSNA cohort had ALND after positive-SLNs. ALND was performed in a second surgery in 10 patients (18.5%) in the H&E cohort for intraoperative FS false negative results, 90% being micrometastasis. 42 out of 44 patients (95.5%) in the OSNA cohort had an ALND in the same surgery (p = 0.03). CONCLUSIONS:OSNA assay detects SLNs metastases as accurately as conventional pathology in the NAC setting. Intraoperative definitive assessment of the SLN by OSNA reduces the need for a second surgery for ALND in 18.5% of breast cancerpatients with a positive-SLN after NAC.
Authors: Anne Grabenstetter; Tracy-Ann Moo; Sabina Hajiyeva; Peter J Schüffler; Pallavi Khattar; Maria A Friedlander; Maura A McCormack; Monica Raiss; Emily C Zabor; Andrea Barrio; Monica Morrow; Marcia Edelweiss Journal: Am J Surg Pathol Date: 2019-10 Impact factor: 6.394
Authors: B Vieites; M Á López-García; M D Martín-Salvago; C L Ramirez-Tortosa; R Rezola; M Sancho; L López-Vilaró; F Villardell; O Burgués; B Fernández-Rodriguez; L Alfaro; V Peg Journal: Clin Transl Oncol Date: 2021-01-31 Impact factor: 3.405