Axillary staging based on molecular analysis: Results of the B-CLOSER-II study
Por:
Sansano, I, Vieites, B, de Salas, M, Garcia, C, Amendoeira, I, Bernet, L, Perez-Garcia, J, Espinosa-Bravo, M, Rubio, I, Cajal, S and Peg, V
Publicada:
1 nov 2020
Resumen:
Introduction: Axillary staging (pN) is a strong predictor of outcome in early stage breast cancer yet following the publication of the Z0011 trial there has been an increasing tendency to spare lymph node dissection. Automated molecular detection of cytokeratin 19mRNA by one-step nucleic acid amplification (OSNA) has been demon-strated to be an accurate method to assess sentinel lymph node (SLN) metastasis. In this study we compare histological and molecular methods following complete axillary lymph node dissection (cALND), determine whether molecular axillary staging affects survival, and evaluate the predictive and prognostic value of total tumor load in ALND (AD-TTL) and in all positive nodes (G-TTL).
Material and methods: Axillary lymph nodes were collected from 102 patients with primary breast cancer with histological confirmation of axillary involvement (cN+) or positive SLN. The central 1-mm portion of each nonSLN was processed for hematoxylin-eosin staining and the remaining tissue was analyzed by OSNA.
Results: Non-SLNs were diagnosed as positive in 72 out of 102 patients (70.6 %) on OSNA compared with only 53 (52 %) on histology (p < 0.01). Thirteen patients would have changed staging if the diagnoses provided had been by molecular methods (p < 0.01), but without a change in prognosis. AD-TTL and G-TTL were predictive of recurrence and mortality.
Conclusions: Compared to molecular detection, histological examination significantly underestimates the frequency of axillary node metastases. However, the increase in pN did not show a clinical effect on survival in those patients.
Filiaciones:
Sansano, I:
Hosp Univ Vall dHebron, Dept Pathol, Barcelona 08035, Spain
Univ Autonoma Barcelona, Dept Ciencies Morfol, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Vieites, B:
Hosp Univ Virgen Rocio, Dept Pathol, Avda Manuel Siurot S-N, Seville 41013, Spain
de Salas, M:
Complejo Asistencial Univ Salamanca, Hosp Univ Salamanca, Dept Pathol, Paseo San Vicente 58-182, Salamanca 37007, Spain
Garcia, C:
Complejo Asistencial Univ Salamanca, Hosp Univ Salamanca, Dept Pathol, Paseo San Vicente 58-182, Salamanca 37007, Spain
Amendoeira, I:
Ctr Hosp Univ S Joao, Dept Pathol, Alameda Prof Hernani Monteiro, P-4200319 Porto, Portugal
Univ Porto, Inst Mol Pathol & Immunol, Ipatimup, Porto, Portugal
:
Hosp Univ La Ribera, Dept Pathol, Ctra Corbera,Km 1, Valencia 46600, Spain
Perez-Garcia, J:
Quiron Salud Grp, IOB Inst Oncol, Madrid, Spain
Quiron Salud Grp, IOB Inst Oncol, Barcelona, Spain
Espinosa-Bravo, M:
Hosp Univ Vall dHebron, Breast Canc Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Rubio, I:
Clin Univ Navarra, Breast Canc Unit, Calle Marquesado Sta Marta 1, Madrid 28027, Spain
Cajal, S:
Hosp Univ Vall dHebron, Dept Pathol, Barcelona 08035, Spain
Univ Autonoma Barcelona, Dept Ciencies Morfol, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Spanish Med Res Network Ctr Oncol CIBERONC, Madrid, Spain
Peg, V:
Hosp Univ Vall dHebron, Dept Pathol, Barcelona 08035, Spain
Univ Autonoma Barcelona, Dept Ciencies Morfol, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Spanish Med Res Network Ctr Oncol CIBERONC, Madrid, Spain
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