Axillary conservation: intraoperative one step nucleic acid assay should replace preoperative ultrasound-guided biopsy staging of the axilla in cT1-2 cN0 breast cancer.
Association of Breast Surgery ePoster Library. Inua B. 05/15/17; 166310; P025
Mr. Bello Inua
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Abstract
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Introduction: Conservative management of the low-burden node-positive axilla in early breast cancer is an emerging practice. Preoperative axillary staging with ultrasound (AUS) ± biopsy (AUSB) has only two outcomes, whereas sentinel lymph node biopsy (SLNB) with one-step nucleic acid cytokeratin-19 amplification assay (OSNA) provides intraoperative quantitative assessment of axillary disease burden. We compared these techniques on how well they inform the decision to adopt axillary conservation.
Methods: A retrospective, single-centre, cohort study of 1315 consecutive patients diagnosed with breast cancer (between December 2012 and August 2015) was undertaken. All patients received AUS ± AUSB. Patients with a normal ultrasound (AUS-) or negative biopsy (AUSB-) followed by SLNB with OSNA ± axillary lymph node dissection (ALND), and those with a positive AUSB (AUSB+), were studied. Tests for association were determined using Chi-Square and Fisher's Exact Test.
Results: 266 (20.2%) patients with cT1-3 cN0 staging received 271 AUSBs. 191/257 biopsies were positive (≥ L4), 66 were negative (≤ L3). 683 patients with an AUS-/AUSB- assessment underwent SLNB with OSNA. AUS sensitivity and negative predictive value (NPV) were 57.2 (0.52 – 0.63, 95% CI) and 0.81 (0.79 – 0.82), respectively. Sensitivity and NPV for OSNA, using a total tumour load (TTL) cut-off of 15000 copies/μL for predicting ≥ 2 macrometastases were 0.82 (0.71 – 0.92) and 0.98 (0.97 – 0.99)(P< 0.0001, OSNA vs AUS).
Conclusions: 50% of cT1-2 AUSB+ patients had ≤ 2 positive nodes and were potentially overtreated with ALND. Unlike AUSB+, SLNB + OSNA using TTL, confidently predicts ≥ 2 nodal macrometastasis, facilitating axillary conservation.
Methods: A retrospective, single-centre, cohort study of 1315 consecutive patients diagnosed with breast cancer (between December 2012 and August 2015) was undertaken. All patients received AUS ± AUSB. Patients with a normal ultrasound (AUS-) or negative biopsy (AUSB-) followed by SLNB with OSNA ± axillary lymph node dissection (ALND), and those with a positive AUSB (AUSB+), were studied. Tests for association were determined using Chi-Square and Fisher's Exact Test.
Results: 266 (20.2%) patients with cT1-3 cN0 staging received 271 AUSBs. 191/257 biopsies were positive (≥ L4), 66 were negative (≤ L3). 683 patients with an AUS-/AUSB- assessment underwent SLNB with OSNA. AUS sensitivity and negative predictive value (NPV) were 57.2 (0.52 – 0.63, 95% CI) and 0.81 (0.79 – 0.82), respectively. Sensitivity and NPV for OSNA, using a total tumour load (TTL) cut-off of 15000 copies/μL for predicting ≥ 2 macrometastases were 0.82 (0.71 – 0.92) and 0.98 (0.97 – 0.99)(P< 0.0001, OSNA vs AUS).
Conclusions: 50% of cT1-2 AUSB+ patients had ≤ 2 positive nodes and were potentially overtreated with ALND. Unlike AUSB+, SLNB + OSNA using TTL, confidently predicts ≥ 2 nodal macrometastasis, facilitating axillary conservation.
Introduction: Conservative management of the low-burden node-positive axilla in early breast cancer is an emerging practice. Preoperative axillary staging with ultrasound (AUS) ± biopsy (AUSB) has only two outcomes, whereas sentinel lymph node biopsy (SLNB) with one-step nucleic acid cytokeratin-19 amplification assay (OSNA) provides intraoperative quantitative assessment of axillary disease burden. We compared these techniques on how well they inform the decision to adopt axillary conservation.
Methods: A retrospective, single-centre, cohort study of 1315 consecutive patients diagnosed with breast cancer (between December 2012 and August 2015) was undertaken. All patients received AUS ± AUSB. Patients with a normal ultrasound (AUS-) or negative biopsy (AUSB-) followed by SLNB with OSNA ± axillary lymph node dissection (ALND), and those with a positive AUSB (AUSB+), were studied. Tests for association were determined using Chi-Square and Fisher's Exact Test.
Results: 266 (20.2%) patients with cT1-3 cN0 staging received 271 AUSBs. 191/257 biopsies were positive (≥ L4), 66 were negative (≤ L3). 683 patients with an AUS-/AUSB- assessment underwent SLNB with OSNA. AUS sensitivity and negative predictive value (NPV) were 57.2 (0.52 – 0.63, 95% CI) and 0.81 (0.79 – 0.82), respectively. Sensitivity and NPV for OSNA, using a total tumour load (TTL) cut-off of 15000 copies/μL for predicting ≥ 2 macrometastases were 0.82 (0.71 – 0.92) and 0.98 (0.97 – 0.99)(P< 0.0001, OSNA vs AUS).
Conclusions: 50% of cT1-2 AUSB+ patients had ≤ 2 positive nodes and were potentially overtreated with ALND. Unlike AUSB+, SLNB + OSNA using TTL, confidently predicts ≥ 2 nodal macrometastasis, facilitating axillary conservation.
Methods: A retrospective, single-centre, cohort study of 1315 consecutive patients diagnosed with breast cancer (between December 2012 and August 2015) was undertaken. All patients received AUS ± AUSB. Patients with a normal ultrasound (AUS-) or negative biopsy (AUSB-) followed by SLNB with OSNA ± axillary lymph node dissection (ALND), and those with a positive AUSB (AUSB+), were studied. Tests for association were determined using Chi-Square and Fisher's Exact Test.
Results: 266 (20.2%) patients with cT1-3 cN0 staging received 271 AUSBs. 191/257 biopsies were positive (≥ L4), 66 were negative (≤ L3). 683 patients with an AUS-/AUSB- assessment underwent SLNB with OSNA. AUS sensitivity and negative predictive value (NPV) were 57.2 (0.52 – 0.63, 95% CI) and 0.81 (0.79 – 0.82), respectively. Sensitivity and NPV for OSNA, using a total tumour load (TTL) cut-off of 15000 copies/μL for predicting ≥ 2 macrometastases were 0.82 (0.71 – 0.92) and 0.98 (0.97 – 0.99)(P< 0.0001, OSNA vs AUS).
Conclusions: 50% of cT1-2 AUSB+ patients had ≤ 2 positive nodes and were potentially overtreated with ALND. Unlike AUSB+, SLNB + OSNA using TTL, confidently predicts ≥ 2 nodal macrometastasis, facilitating axillary conservation.
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