一步核酸扩增（OSNA）全淋巴结检测在乳腺癌前哨淋巴结（SLN）分析中的优势。
Advantages of one step nucleic acid amplification (OSNA) whole node assay in sentinel lymph node (SLN) analysis in breast cancer.
作者信息
Santaballa Ana, De La Cueva Helena, Salvador Carmen, García-Martínez Ana M, Guarín María J, Lorente David, Palomar Laura, Aznar Ismael, Dobón Fernando, Bello Pilar
机构信息
Medical Oncology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
出版信息
Springerplus. 2013 Oct 17;2:542. doi: 10.1186/2193-1801-2-542. eCollection 2013.
BACKGROUND
The purpose of this study is to present our first results of sentinel node analysis (SLN) by one step nucleic acid amplification (OSNA) in routine clinical practice in our centre and compare them with the results of classic histopathological analysis in a historical cohort from our same institution.
METHODS
407 patients (total study population) with early breast cancer and no clinical nodal involvement underwent SLN biopsy in our institution. The SLN was analysed by OSNA in 164 biopsies. OSNA results were compared with the conventional histopathology study of 244 patients who had undergone SLN biopsy previously. The characteristics of the patients in both groups were evaluated and a comparison was made of the rate of metastases detected by both methods and of the surgical procedures needed in each group. We also investigated the state of non-sentinel lymph nodes if micrometastases where found in SLN.
RESULTS
SLN biopsy result was considered as positive in 45 patients (28%) in the OSNA group and in 58 in the historical group (24%). There was no difference in the rate of macrometastases (16,5% for OSNA, 20% for HE) but we found differences in the rate of micrometastases (11% for OSNA and 3,6% for HE p = 0.0007). Axillary lymphadenectomy (ALND) was performed in 43/45 cases in the OSNA group and in 51/58 of the historical group. In all patients diagnosed by OSNA, ALND was performed during the initial surgical procedure. In the historical cohort ALND was performed during the initial surgical procedure in 41 patients and in a second surgical procedure in 10 patients. Patients from both groups with micrometastases in the SLN had no metastases in other nodes when the ALND was performed.
CONCLUSIONS
OSNA analysis allows the detection of SLN metastases as precisely as conventional pathology with an increased detection of micrometastases. The OSNA method can reduce the need of a deferred lymphadenectomy.
背景
本研究旨在展示我们中心在常规临床实践中通过一步核酸扩增（OSNA）进行前哨淋巴结分析（SLN）的首批结果，并将其与来自同一机构的历史队列中经典组织病理学分析的结果进行比较。
方法
407例早期乳腺癌且无临床淋巴结受累的患者（总研究人群）在我们机构接受了前哨淋巴结活检。164例活检通过OSNA分析前哨淋巴结。将OSNA结果与244例先前接受过前哨淋巴结活检患者的传统组织病理学研究结果进行比较。评估两组患者的特征，并比较两种方法检测到的转移率以及每组所需的手术程序。如果在前哨淋巴结中发现微转移，我们还会调查非前哨淋巴结的情况。
结果
OSNA组45例患者（28%）的前哨淋巴结活检结果被视为阳性，历史组58例患者（24%）的结果为阳性。宏转移率无差异（OSNA为16.5%，苏木精-伊红染色为20%），但我们发现微转移率存在差异（OSNA为11%，苏木精-伊红染色为3.6%，p = 0.0007）。OSNA组43/45例患者和历史组51/58例患者进行了腋窝淋巴结清扫术（ALND）。在所有通过OSNA诊断的患者中，ALND在初次手术过程中进行。在历史队列中，41例患者在初次手术过程中进行了ALND，10例患者在二次手术中进行。当进行ALND时，两组在前哨淋巴结中有微转移的患者在其他淋巴结中均无转移。
结论
OSNA分析能够像传统病理学一样精确地检测前哨淋巴结转移，且微转移的检测率有所提高。OSNA方法可以减少延期淋巴结清扫术的需求。
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