Is it the end of the road for OSNA? - Definitely not; await POSNOC
Association of Breast Surgery ePoster Library. Khan M. 05/15/17; 166219; P058
Mr. Mashuk Khan
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Abstract
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Introduction
One-step nucleic acid amplification (OSNA) allows intraoperative assessment of the sentinel lymph node (SLN) which can enable an axillary node clearance to be performed in the same operation. We report our experience of OSNA for the intraoperative assessment of the SLN in our institution.
Methods
All patients with node negative breast cancer (clinically and radiologically) undergoing SLN biopsy between June 2011 and March 2016 were included. Rates of axillary node positivity, specifically macrometastatic and micrometastatic disease, as detected by OSNA were collected. These were compared with a pre-OSNA group of 411 patients who underwent intraoperative assessment by Touch Imprint Cytology. Data was analysed using the Chi-square test.
Results
807 patients had their SLN assessed by OSNA. The SLN was positive in 292 patients (36.5%). Of these patients, 138 (17.3%) had macrometastatic disease and 154 (19.2%) had micrometastatic disease. The node positivity rate was significantly more when compared to the pre-OSNA group (24.6%; p=0.0001). Whilst there was no significant increase in the rate of macrometastatic disease detected on OSNA (21.15% vs 17.3 %; p=0.052), there was a significant increase in micrometastases identified (19.2% vs. 3.5%; p=0.0009).
Conclusion
OSNA is superior at detecting metastases, especially micrometastatic disease, in the SLN. Micrometastatic disease is currently managed as node negative disease by most breast units. We await the results of the POSNOC trial which may further influence practice. OSNA reliably informs the operator of nodal status intraoperatively, allowing for definitive axillary surgery to be performed during the same operation.
One-step nucleic acid amplification (OSNA) allows intraoperative assessment of the sentinel lymph node (SLN) which can enable an axillary node clearance to be performed in the same operation. We report our experience of OSNA for the intraoperative assessment of the SLN in our institution.
Methods
All patients with node negative breast cancer (clinically and radiologically) undergoing SLN biopsy between June 2011 and March 2016 were included. Rates of axillary node positivity, specifically macrometastatic and micrometastatic disease, as detected by OSNA were collected. These were compared with a pre-OSNA group of 411 patients who underwent intraoperative assessment by Touch Imprint Cytology. Data was analysed using the Chi-square test.
Results
807 patients had their SLN assessed by OSNA. The SLN was positive in 292 patients (36.5%). Of these patients, 138 (17.3%) had macrometastatic disease and 154 (19.2%) had micrometastatic disease. The node positivity rate was significantly more when compared to the pre-OSNA group (24.6%; p=0.0001). Whilst there was no significant increase in the rate of macrometastatic disease detected on OSNA (21.15% vs 17.3 %; p=0.052), there was a significant increase in micrometastases identified (19.2% vs. 3.5%; p=0.0009).
Conclusion
OSNA is superior at detecting metastases, especially micrometastatic disease, in the SLN. Micrometastatic disease is currently managed as node negative disease by most breast units. We await the results of the POSNOC trial which may further influence practice. OSNA reliably informs the operator of nodal status intraoperatively, allowing for definitive axillary surgery to be performed during the same operation.
Introduction
One-step nucleic acid amplification (OSNA) allows intraoperative assessment of the sentinel lymph node (SLN) which can enable an axillary node clearance to be performed in the same operation. We report our experience of OSNA for the intraoperative assessment of the SLN in our institution.
Methods
All patients with node negative breast cancer (clinically and radiologically) undergoing SLN biopsy between June 2011 and March 2016 were included. Rates of axillary node positivity, specifically macrometastatic and micrometastatic disease, as detected by OSNA were collected. These were compared with a pre-OSNA group of 411 patients who underwent intraoperative assessment by Touch Imprint Cytology. Data was analysed using the Chi-square test.
Results
807 patients had their SLN assessed by OSNA. The SLN was positive in 292 patients (36.5%). Of these patients, 138 (17.3%) had macrometastatic disease and 154 (19.2%) had micrometastatic disease. The node positivity rate was significantly more when compared to the pre-OSNA group (24.6%; p=0.0001). Whilst there was no significant increase in the rate of macrometastatic disease detected on OSNA (21.15% vs 17.3 %; p=0.052), there was a significant increase in micrometastases identified (19.2% vs. 3.5%; p=0.0009).
Conclusion
OSNA is superior at detecting metastases, especially micrometastatic disease, in the SLN. Micrometastatic disease is currently managed as node negative disease by most breast units. We await the results of the POSNOC trial which may further influence practice. OSNA reliably informs the operator of nodal status intraoperatively, allowing for definitive axillary surgery to be performed during the same operation.
One-step nucleic acid amplification (OSNA) allows intraoperative assessment of the sentinel lymph node (SLN) which can enable an axillary node clearance to be performed in the same operation. We report our experience of OSNA for the intraoperative assessment of the SLN in our institution.
Methods
All patients with node negative breast cancer (clinically and radiologically) undergoing SLN biopsy between June 2011 and March 2016 were included. Rates of axillary node positivity, specifically macrometastatic and micrometastatic disease, as detected by OSNA were collected. These were compared with a pre-OSNA group of 411 patients who underwent intraoperative assessment by Touch Imprint Cytology. Data was analysed using the Chi-square test.
Results
807 patients had their SLN assessed by OSNA. The SLN was positive in 292 patients (36.5%). Of these patients, 138 (17.3%) had macrometastatic disease and 154 (19.2%) had micrometastatic disease. The node positivity rate was significantly more when compared to the pre-OSNA group (24.6%; p=0.0001). Whilst there was no significant increase in the rate of macrometastatic disease detected on OSNA (21.15% vs 17.3 %; p=0.052), there was a significant increase in micrometastases identified (19.2% vs. 3.5%; p=0.0009).
Conclusion
OSNA is superior at detecting metastases, especially micrometastatic disease, in the SLN. Micrometastatic disease is currently managed as node negative disease by most breast units. We await the results of the POSNOC trial which may further influence practice. OSNA reliably informs the operator of nodal status intraoperatively, allowing for definitive axillary surgery to be performed during the same operation.
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