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Title

Axillary staging based on molecular analysis: Results of the B-CLOSER-II study

AuthorsSansano, Irene; Vieites, Begoña; Sancho de Salas, Magdalena; García, Carmen; Amendoeira, Isabel; Bernet, Laia; Pérez-García, José Manuel; Espinosa-Bravo, Martín; Rubio, Isabel T.; Ramón y Cajal, Santiago; Peg, Vicente
KeywordsMolecular axillary staging
Prognosis
Breast cancer
OSNA
Issue DateNov-2020
PublisherElsevier BV
CitationPathology Research and Practice 216(11): 153197 (2020)
AbstractIntroduction 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 demonstrated 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 non-SLN 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.
Publisher version (URL)http://dx.doi.org/10.1016/j.prp.2020.153197
URIhttp://hdl.handle.net/10261/237627
Identifiersdoi: 10.1016/j.prp.2020.153197
issn: 0344-0338
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