Does total tumour load in Sentinel lymph node biopsy assessed by OSNA predict further axillary node disease? Can it stratify which patients may benefit from axillary clearance?
Association of Breast Surgery ePoster Library. McKenna A. 05/13/19; 257053; P009
Adrian McKenna
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P009
Topic: Axilla
INTRODUCTION:There is a lack of consensus regarding the optimum axillary management of early breast cancer, especially in women with only one or two node involvement. More than 50% of patients who proceed to axillary clearance following sentinel lymph node biopsy have no further nodal involvement. One-Step Nucleic acid Amplification (OSNA) is a molecular assay of cytokeratin-19 (CK 19) mRNA which can be utilised intra-operatively for detection of lymph node metastases in breast carcinoma. Our aim is to identify a correlation of CK-19 total tumour load (TTL) and further axillary disease to aid intra-operative decision making regarding complete axillary dissection. Methods .A retrospective single centre analysis of 1131 consecutive patients (Nov 2012 to Dec 2016) with invasive breast carcinoma who underwent intra-operative OSNA assessment was performed.Patient demographics, surgical and histopathological data were analysed. Results: 490 (43.3%) patients had nodal positivity when assessed by OSNA. 302 (26.7%) patients had micrometastastic disease and 188 (16.6%) patients had macrometastastic disease. In the macrometastatic group, 138 (73.1%) of patients proceeded to axillary node clearance. Only 59 (42.8%) patients out of this cohort had further nodal involvement. Utilising a CK 19 copy number of 20,000 as a cut-off appeared to predict further axillary disease.Total CK-19 copy No.No. of patientsAxillary node clearanceFurther LN involved<2000039395 (12.8%)>20000999954 (54.5%)CONCLUSIONA CK-19 total copy number of >20,000 may help predict the likelihood of further axillary disease, aid intra-operative decision making, and avoid unnecessary further axillary surgery.
Topic: Axilla
INTRODUCTION:There is a lack of consensus regarding the optimum axillary management of early breast cancer, especially in women with only one or two node involvement. More than 50% of patients who proceed to axillary clearance following sentinel lymph node biopsy have no further nodal involvement. One-Step Nucleic acid Amplification (OSNA) is a molecular assay of cytokeratin-19 (CK 19) mRNA which can be utilised intra-operatively for detection of lymph node metastases in breast carcinoma. Our aim is to identify a correlation of CK-19 total tumour load (TTL) and further axillary disease to aid intra-operative decision making regarding complete axillary dissection. Methods .A retrospective single centre analysis of 1131 consecutive patients (Nov 2012 to Dec 2016) with invasive breast carcinoma who underwent intra-operative OSNA assessment was performed.Patient demographics, surgical and histopathological data were analysed. Results: 490 (43.3%) patients had nodal positivity when assessed by OSNA. 302 (26.7%) patients had micrometastastic disease and 188 (16.6%) patients had macrometastastic disease. In the macrometastatic group, 138 (73.1%) of patients proceeded to axillary node clearance. Only 59 (42.8%) patients out of this cohort had further nodal involvement. Utilising a CK 19 copy number of 20,000 as a cut-off appeared to predict further axillary disease.Total CK-19 copy No.No. of patientsAxillary node clearanceFurther LN involved<2000039395 (12.8%)>20000999954 (54.5%)CONCLUSIONA CK-19 total copy number of >20,000 may help predict the likelihood of further axillary disease, aid intra-operative decision making, and avoid unnecessary further axillary surgery.
P009
Topic: Axilla
INTRODUCTION:There is a lack of consensus regarding the optimum axillary management of early breast cancer, especially in women with only one or two node involvement. More than 50% of patients who proceed to axillary clearance following sentinel lymph node biopsy have no further nodal involvement. One-Step Nucleic acid Amplification (OSNA) is a molecular assay of cytokeratin-19 (CK 19) mRNA which can be utilised intra-operatively for detection of lymph node metastases in breast carcinoma. Our aim is to identify a correlation of CK-19 total tumour load (TTL) and further axillary disease to aid intra-operative decision making regarding complete axillary dissection. Methods .A retrospective single centre analysis of 1131 consecutive patients (Nov 2012 to Dec 2016) with invasive breast carcinoma who underwent intra-operative OSNA assessment was performed.Patient demographics, surgical and histopathological data were analysed. Results: 490 (43.3%) patients had nodal positivity when assessed by OSNA. 302 (26.7%) patients had micrometastastic disease and 188 (16.6%) patients had macrometastastic disease. In the macrometastatic group, 138 (73.1%) of patients proceeded to axillary node clearance. Only 59 (42.8%) patients out of this cohort had further nodal involvement. Utilising a CK 19 copy number of 20,000 as a cut-off appeared to predict further axillary disease.Total CK-19 copy No.No. of patientsAxillary node clearanceFurther LN involved<2000039395 (12.8%)>20000999954 (54.5%)CONCLUSIONA CK-19 total copy number of >20,000 may help predict the likelihood of further axillary disease, aid intra-operative decision making, and avoid unnecessary further axillary surgery.
Topic: Axilla
INTRODUCTION:There is a lack of consensus regarding the optimum axillary management of early breast cancer, especially in women with only one or two node involvement. More than 50% of patients who proceed to axillary clearance following sentinel lymph node biopsy have no further nodal involvement. One-Step Nucleic acid Amplification (OSNA) is a molecular assay of cytokeratin-19 (CK 19) mRNA which can be utilised intra-operatively for detection of lymph node metastases in breast carcinoma. Our aim is to identify a correlation of CK-19 total tumour load (TTL) and further axillary disease to aid intra-operative decision making regarding complete axillary dissection. Methods .A retrospective single centre analysis of 1131 consecutive patients (Nov 2012 to Dec 2016) with invasive breast carcinoma who underwent intra-operative OSNA assessment was performed.Patient demographics, surgical and histopathological data were analysed. Results: 490 (43.3%) patients had nodal positivity when assessed by OSNA. 302 (26.7%) patients had micrometastastic disease and 188 (16.6%) patients had macrometastastic disease. In the macrometastatic group, 138 (73.1%) of patients proceeded to axillary node clearance. Only 59 (42.8%) patients out of this cohort had further nodal involvement. Utilising a CK 19 copy number of 20,000 as a cut-off appeared to predict further axillary disease.Total CK-19 copy No.No. of patientsAxillary node clearanceFurther LN involved<2000039395 (12.8%)>20000999954 (54.5%)CONCLUSIONA CK-19 total copy number of >20,000 may help predict the likelihood of further axillary disease, aid intra-operative decision making, and avoid unnecessary further axillary surgery.
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