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Triple assessment of sentinel lymph node metastasis in early breast cancer using preoperative CTLG, intraoperative fluorescence navigation and OSNA

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Abstract

Background

Sentinel lymph node biopsy (SLNB) became a standard surgical procedure for patients with early breast cancer; however, the optimal method of sentinel lymph node (SLN) identification remains controversial. The current study presents the protocol of our institution for preoperative and intraoperative SLN detection.

Methods

Fifty female patients with early breast cancer and clinically node-negative axilla were enrolled in this study. All patients underwent preoperative CT lymphography (CTLG), intraoperative SLNB using fluorescence navigation, intraoperative one-step nucleic acid amplification (OSNA) and postoperative hematoxylin and eosin histopathological analysis. Prediction of metastasis by CTLG and detection of metastasis by OSNA were compared to results of histopathology as standard reference.

Results

SLN were identified by preoperative CTLG and intraoperative SLNB with fluorescence navigation in all patients, the identification rate was 100 %. SLN metastases were detected as positive by OSNA in 9 patients (18 %), 4 were (++), 4 were (+) and 1 was (+I). SLN metastases were detected as positive by histopathology in 10 patients (20 %). The concordance rate between OSNA and permanent sections was 90 %. The negative predictive value of CTLG was 80 %.

Conclusion

Use of CTLG and fluorescence navigation made performing SLNB with high accuracy possible in institutions that cannot use the radioisotope method. OSNA provided accurate intraoperative method, allowing for completion of axillary node dissection during surgery and avoidance of second surgical procedure in patients with positive SLNs, thereby reducing patient distress and, finally, saving hospital costs.

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Abbreviations

ALND:

Axillary lymph node dissection

BCS:

Breast conserving surgery

BMI:

Body mass index

CTLG:

Computed tomography lymphography

H&E:

Hematoxylin and eosin

NPV:

Negative predictive value

OSNA:

One-step nucleic acid amplification

PPV:

Positive predictive value

QRT-PCR:

Quantitative reverse transcription-PCR

RI:

Radioisotope

SLN:

Sentinel lymph node

SLNB:

Sentinel lymph node biopsy

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Oncological Medical Services, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan

    Mohamed Mokhtar & Kazuya Kondo

  2. Department of Oncological Surgery, Minia Oncology Institute, Minya, 61111, Egypt

    Mohamed Mokhtar

  3. Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan

    Yukiko Tadokoro, Misako Nakagawa, Masami Morimoto, Hirokazu Takechi & Akira Tangoku

Authors
  1. Mohamed Mokhtar
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  2. Yukiko Tadokoro
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  3. Misako Nakagawa
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  4. Masami Morimoto
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  5. Hirokazu Takechi
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  6. Kazuya Kondo
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  7. Akira Tangoku
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Corresponding author

Correspondence to Yukiko Tadokoro.

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Mokhtar, M., Tadokoro, Y., Nakagawa, M. et al. Triple assessment of sentinel lymph node metastasis in early breast cancer using preoperative CTLG, intraoperative fluorescence navigation and OSNA. Breast Cancer 23, 202–210 (2016). https://doi.org/10.1007/s12282-014-0551-1

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  • DOI: https://doi.org/10.1007/s12282-014-0551-1

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