Pathmanathan Nirmala, Renthawa Jasveen, French James R, Edstrom-Elder Elizabeth, Hall Geoffrey, Mahajan Hema, Teh Christina, Bilous Michael A
Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia; Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg. 2014 Oct;84(10):730-4. doi: 10.1111/ans.12668. Epub 2014 Jun 5.
Sentinel lymph node biopsy in breast cancer is a routine technique for staging the axilla. The two most common methods of intraoperative histopathological assessment, imprint cytology and frozen section, are hampered by poor sensitivity and lack standardized methodology. The one-step nuclei acid amplification (OSNA) assay is a rapid quantification of cytokeratin 19 mRNA. This prospective study compared an existing intraoperative imprint cytology protocol with the OSNA system.
Of the 110 prospectively recruited patients, 98 met the inclusion criteria with a total of 170 lymph nodes. Intraoperative sentinel nodes were serially sectioned and imprints made of each cut surface for cytological assessment. Alternate slices were submitted for OSNA while the remaining slices were for final histopathological evaluation with six hematoxylin and eosin levels and one AE1/AE3 immunoperoxidase stain of each slice.
On histopathological analysis, 24.5% of patients (16.5% of nodes) had sentinel node metastases and 3.1% (2.4%) had isolated tumour cells. With isolated tumour cells cases taken as negative, the sensitivity of imprint cytology and OSNA compared with histopathology were 66.7% on patient basis (71.4% on per-node basis) and 95.8% (89.3%), respectively. One of 22 patients with macrometastases and two of three micrometastases were designated negative while five false-positive nodes were identified with OSNA, likely due to tissue allocation bias.
The OSNA assay is highly sensitive in comparison with imprint cytology and may be used effectively in the intraoperative setting. Clinical follow-up studies are warranted to further assess its use in routine practice.
乳腺癌前哨淋巴结活检是腋窝分期的常规技术。术中组织病理学评估的两种最常见方法，即印片细胞学检查和冰冻切片检查，因敏感性差且缺乏标准化方法而受到限制。一步核酸扩增（OSNA）检测是一种对细胞角蛋白19 mRNA进行快速定量的方法。这项前瞻性研究将现有的术中印片细胞学方案与OSNA系统进行了比较。
在110例前瞻性招募的患者中，98例符合纳入标准，共有170个淋巴结。术中对前哨淋巴结进行连续切片，并对每个切面制作印片进行细胞学评估。每隔一片提交进行OSNA检测，其余切片用于最终组织病理学评估，对每片进行六个苏木精和伊红水平以及一个AE1/AE3免疫过氧化物酶染色。
组织病理学分析显示，24.5%的患者（16.5%的淋巴结）有前哨淋巴结转移，3.1%（2.4%）有孤立肿瘤细胞。将孤立肿瘤细胞病例视为阴性，与组织病理学相比，印片细胞学和OSNA在患者层面的敏感性分别为66.7%（在每个淋巴结层面为71.4%）和95.8%（89.3%）。22例有大转移灶的患者中有1例、3例微转移灶患者中有2例被判定为阴性，而OSNA检测发现5例假阳性淋巴结，可能是由于组织分配偏差。
与印片细胞学相比，OSNA检测具有高度敏感性，可在术中有效使用。有必要进行临床随访研究，以进一步评估其在常规实践中的应用。
