The Use of Intraoperative Lymph Node Analysis with Neoadjuvant Chemotherapy: A three-year retrospective cohort study
Association of Breast Surgery ePoster Library. Olivier J. 05/13/19; 257064; P020
Mr. James Olivier
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P020
Topic: Axilla
Introduction:The place for one-step nucleic amplification intraoperative analysis of lymph nodes (OSNA) in the neoadjuvant setting continues to be debated. The significance of nodal micrometastases remains unclear. Our aim was to review our experience and results of OSNA in patients with breast cancer who had received neoadjuvant chemotherapy. Methods :Using a combination of online systems, data on all patients who had undergone OSNA over the last three years was collated to include response of nodes to chemotherapy, presence of macrometastases/micrometastases, receptor status and histological results of any subsequent axillary clearance. Results:68/288 OSNA patients had undergone neoadjuvant chemotherapy. Nodal macrometastases were found in 4 (5.8%), all underwent axillary clearance and 1 (25%) had positive histological nodes. Micrometastases were present in a further 15 (22%) patients, 6 (40%) of whom proceeded to clearance; 2 (33%) had further node involvement.3 (4.4%) patients proceeded to clearance with negative OSNA results of whom 1 (33%) had nodal involvement. 2 of these 3 patients had pre-operatively involved nodes on imaging.HER2 positivity was seen in 75% of macrometastases but 33% of micrometastases.Conclusion:In conclusion, there remains a need for further evidence and guidance for appropriate treatment of micrometastatic disease. Preoperative imaging and receptor status do not appear to provide a marker of positive nodal involvement in our cohort. Despite this, the study does demonstrate the effective use of OSNA over a three-year period, with only 1 missed metastasis, which was picked up via the use of preoperative imaging and clinical judgment
Topic: Axilla
Introduction:The place for one-step nucleic amplification intraoperative analysis of lymph nodes (OSNA) in the neoadjuvant setting continues to be debated. The significance of nodal micrometastases remains unclear. Our aim was to review our experience and results of OSNA in patients with breast cancer who had received neoadjuvant chemotherapy. Methods :Using a combination of online systems, data on all patients who had undergone OSNA over the last three years was collated to include response of nodes to chemotherapy, presence of macrometastases/micrometastases, receptor status and histological results of any subsequent axillary clearance. Results:68/288 OSNA patients had undergone neoadjuvant chemotherapy. Nodal macrometastases were found in 4 (5.8%), all underwent axillary clearance and 1 (25%) had positive histological nodes. Micrometastases were present in a further 15 (22%) patients, 6 (40%) of whom proceeded to clearance; 2 (33%) had further node involvement.3 (4.4%) patients proceeded to clearance with negative OSNA results of whom 1 (33%) had nodal involvement. 2 of these 3 patients had pre-operatively involved nodes on imaging.HER2 positivity was seen in 75% of macrometastases but 33% of micrometastases.Conclusion:In conclusion, there remains a need for further evidence and guidance for appropriate treatment of micrometastatic disease. Preoperative imaging and receptor status do not appear to provide a marker of positive nodal involvement in our cohort. Despite this, the study does demonstrate the effective use of OSNA over a three-year period, with only 1 missed metastasis, which was picked up via the use of preoperative imaging and clinical judgment
P020
Topic: Axilla
Introduction:The place for one-step nucleic amplification intraoperative analysis of lymph nodes (OSNA) in the neoadjuvant setting continues to be debated. The significance of nodal micrometastases remains unclear. Our aim was to review our experience and results of OSNA in patients with breast cancer who had received neoadjuvant chemotherapy. Methods :Using a combination of online systems, data on all patients who had undergone OSNA over the last three years was collated to include response of nodes to chemotherapy, presence of macrometastases/micrometastases, receptor status and histological results of any subsequent axillary clearance. Results:68/288 OSNA patients had undergone neoadjuvant chemotherapy. Nodal macrometastases were found in 4 (5.8%), all underwent axillary clearance and 1 (25%) had positive histological nodes. Micrometastases were present in a further 15 (22%) patients, 6 (40%) of whom proceeded to clearance; 2 (33%) had further node involvement.3 (4.4%) patients proceeded to clearance with negative OSNA results of whom 1 (33%) had nodal involvement. 2 of these 3 patients had pre-operatively involved nodes on imaging.HER2 positivity was seen in 75% of macrometastases but 33% of micrometastases.Conclusion:In conclusion, there remains a need for further evidence and guidance for appropriate treatment of micrometastatic disease. Preoperative imaging and receptor status do not appear to provide a marker of positive nodal involvement in our cohort. Despite this, the study does demonstrate the effective use of OSNA over a three-year period, with only 1 missed metastasis, which was picked up via the use of preoperative imaging and clinical judgment
Topic: Axilla
Introduction:The place for one-step nucleic amplification intraoperative analysis of lymph nodes (OSNA) in the neoadjuvant setting continues to be debated. The significance of nodal micrometastases remains unclear. Our aim was to review our experience and results of OSNA in patients with breast cancer who had received neoadjuvant chemotherapy. Methods :Using a combination of online systems, data on all patients who had undergone OSNA over the last three years was collated to include response of nodes to chemotherapy, presence of macrometastases/micrometastases, receptor status and histological results of any subsequent axillary clearance. Results:68/288 OSNA patients had undergone neoadjuvant chemotherapy. Nodal macrometastases were found in 4 (5.8%), all underwent axillary clearance and 1 (25%) had positive histological nodes. Micrometastases were present in a further 15 (22%) patients, 6 (40%) of whom proceeded to clearance; 2 (33%) had further node involvement.3 (4.4%) patients proceeded to clearance with negative OSNA results of whom 1 (33%) had nodal involvement. 2 of these 3 patients had pre-operatively involved nodes on imaging.HER2 positivity was seen in 75% of macrometastases but 33% of micrometastases.Conclusion:In conclusion, there remains a need for further evidence and guidance for appropriate treatment of micrometastatic disease. Preoperative imaging and receptor status do not appear to provide a marker of positive nodal involvement in our cohort. Despite this, the study does demonstrate the effective use of OSNA over a three-year period, with only 1 missed metastasis, which was picked up via the use of preoperative imaging and clinical judgment
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