Banerjee S M, Williams N R, Davidson T I, El Sheikh S, Tran-Dang M, Davison S, Ghosh D, Keshtgar M R S
Royal Free London NHS Foundation Trust, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom.
Division of Surgery and Interventional Science, University College London, United Kingdom.
Eur J Surg Oncol. 2016 May;42(5):641-9. doi: 10.1016/j.ejso.2016.02.245. Epub 2016 Mar 2.
We aimed to determine the effectiveness of CK19 mRNA copy number and tumour related factors in predicting non-sentinel axillary nodal involvement, in order to facilitate the formulation of local treatment guidelines for axillary clearance (ANC) following intra-operative analysis of the sentinel node biopsy (SNB) using one-step nucleic acid amplification (OSNA).
Patients due to have (SNB) at our institution for breast cancer as well as patients with high grade ductal carcinoma in situ with pre-operative negative assessment of the axilla were included. Alternate slices of each node were sent for assessment by either OSNA or histopathology. Immediate ANC was performed if OSNA was positive. The CK19 mRNA nodal copy number, the total tumour load (TTL) measured by summation of mRNA copy numbers of all positive nodes, the nodal status at ANC and tumour characteristics for each patient were recorded. A model of risk probability was constructed using TTL and tumour related factors.
664 nodes were analysed from 425 patients who had SNB performed between 2011 and 2014. ANC was performed on 105 of these patients. The concordance between OSNA and histology was 91.4% and negative predictive value (NPV) was 97%. TTL (p = 0.003) and LVI (p = 0.04) were identified as risk factors for non-sentinel nodal involvement. The risk probability model identified all patients with pN2 disease for ANC.
In the future a decision to perform ANC will be based on a risk stratification model based on TTL and tumour related factors.
我们旨在确定细胞角蛋白19（CK19）信使核糖核酸（mRNA）拷贝数及肿瘤相关因素在预测非前哨腋窝淋巴结受累方面的有效性，以便在使用一步核酸扩增（OSNA）对前哨淋巴结活检（SNB）进行术中分析后，为腋窝清扫术（ANC）制定局部治疗指南提供便利。
纳入在我们机构因乳腺癌接受（SNB）的患者以及术前腋窝评估为阴性的高级别导管原位癌患者。每个淋巴结的交替切片分别送去进行OSNA评估或组织病理学评估。若OSNA结果为阳性，则立即进行ANC。记录每位患者的CK19 mRNA淋巴结拷贝数、通过所有阳性淋巴结mRNA拷贝数总和测得的总肿瘤负荷（TTL）、ANC时的淋巴结状态及肿瘤特征。使用TTL和肿瘤相关因素构建风险概率模型。
对2011年至2014年间接受SNB的425例患者的664个淋巴结进行了分析。其中105例患者接受了ANC。OSNA与组织学之间的一致性为91.4%，阴性预测值（NPV）为97%。TTL（p = 0.003）和淋巴管浸润（LVI，p = 0.04）被确定为非前哨淋巴结受累的危险因素。风险概率模型识别出了所有需要进行ANC的pN2期疾病患者。
未来，ANC决策将基于一个基于TTL和肿瘤相关因素的风险分层模型。
