[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to investigate potential risk factors for synchronous bilateral breast cancer sBBC).
A retrospective analysis was performed of patients diagnosed and treated with operable bilateral breast cancer (BBC) between June 2007 and December 2011. Risk factors for sBBC were evaluated in this cohort and further validated in a prospective observational validation analysis of patients between January 2012 and December 2012. Patients treated with operable unilateral breast cancer during the same period were used as a control group.
A total of 11,247 patients with primary breast cancer underwent operations at the Fudan University Shanghai Cancer Center between June 2007 and December 2012. The incidence of sBBC was 1.6%. The age at diagnosis (HR = 2.4, 95% C.I.: 1.4-4.0, p = 0.001), presence of sclerosing adenosis (HR = 11.8, 95% C.I.: 5.3-26.3, p<0.001), lobular carcinoma component involvement (HR = 5.6, 95% C.I.: 2.6-12.1, p<0.001), and family history of first-degree relatives with breast cancer (HR = 2.0, 95% C.I.: 1.1-3.4, p<0.001) were independent risk factors for sBBC. A subsequent validation study failed to confirm the significance of family history. No significant difference on survival was found between patients with early-stage sBBC and control cases.
Patients with the presence of sclerosing in the affected breast, and lobular carcinoma component involvement may be at high risk for developing sBBC. This study supports the hypothesis that the host-carcinoma biological relationship, especially for the tumor microenvironment, played a critical role in the carcinogenesis of sBBC.
PLoS ONE 01/2014; 9(4):e95185. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To study the clinicopathologic characteristics of mitotically active cellular fibroma (MACF) of the ovary.
The clinicopathologic features of 11 cases of MACF from 2008 to 2012 years were retrospectively reviewed and immunohistochemic EnVision method was performed.
The age of patients ranged from 21 to 65 years (mean = 46 years). The maximum tumor diameter varied from 6 to 16 cm (mean = 9.8 cm). The tumors were densely cellular and composed of intersecting bundles of spindle cells, sometimes associated with storiform pattern. The mitotic count ranged from 4 to 20 per 10 high-power field (mean = 8.4). Atypical mitotic figures were not identified and coagulative tumor necrosis was not found. There was at most mild to moderate degree of nuclear atypia. Immunohistochemically, 8 cases showed positive stain for vimentin and 5 cases expressed diffusely or focally WT-1. In 6 cases, Ki-67 positive index ranged from 5%-30%, including 1 case (10%), and 1 case (30%) in which mitotic figures were 20/10 HPF. CK,AE1/AE3, CD117, CD34, CD99 and desmin were negative in the detected 5 cases. Reticular fiber staining in 2 cases showed dense reticular fibers enveloping individual tumor cells. Ten patients who followed-up range from 4 to 38 months were alive without evidence of recurrence or disease progression. One patient was alive with local recurrence 94 months after surgery.
Cellular fibromatous neoplasm with mitotic count of ≥ 4/10 HPF but relatively bland nuclear features should be considered as MACF rather than ovarian fibrosarcoma. MACF is a group of ovarian tumor which carries a low malignant potential and occasional chance of recurrence.
Zhonghua bing li xue za zhi Chinese journal of pathology 10/2013; 42(10):660-4.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the roles of Sysmex RD100i one-step nucleic acid amplification (OSNA) assay in the intraoperative assessments of breast cancer sentinel lymph nodes (SLNs).
A total of 552 consecutive prospective patients were enrolled from five centers nationwide from February to December 2010. And SLNs were sliced into alternating 2 mm blocks. The odd blocks were tested by the OSNA assay intraoperatively and the even ones assessed by postoperative histology. In addition, intraoperative histological assessments were performed on the even blocks of 211 patients by frozen section and all blocks by touch imprint cytology.
A total of 1188 SLNs were removed. The mean turnaround time of the assay was 37.3 min. There was no significant difference of turnaround time at each center (P = 0.074). As compared to postoperative histology, the overall performance of the assay had an accuracy of 91.4% (1086/1188), a sensitivity of 83.7% (159/190) and a specificity of 92.9% (927/998). The sensitivity of the assay was higher than frozen section (77.6% (59/76) vs 69.7% (53/76), P = 0.286) and was significantly higher than touch imprint cytology (83.6% (158/189) vs 76.2% (144/189), P = 0.044). For nodes with micro-metastases, the sensitivity of the assay was higher than frozen section (8/17 vs 4/17, P = 0.289) and was significantly higher than touch imprint cytology (62.5% (30/48) vs 35.4% (17/48), P = 0.007).
As an accurate and rapid intraoperative assay for assessing breast SLNs, the OSNA assay may replace frozen section and touch imprint cytology for clinical applications.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Breast cancer sentinel lymph node (SLN) biopsy has become a common procedure. The GeneSearch™ Breast Lymph Node Assay is a real-time reverse-transcriptase polymerase chain reaction assay for detecting nodal metastases larger than 0.2 mm. The trial is a prospective multi-center clinical trial conducted to validate the assay in China. METHODS: Four hundred and seventy-nine consecutive prospective patients were enrolled from six centers. SLNs were sectioned along the short axis into multiple blocks. Odd blocks were tested by the assay intra-operatively, and even blocks were assessed by post-operative histology. Six 4- to 6-μm-thick sections were taken every 150 μm per block. In addition, intra-operative histological assessments were performed on the even blocks of 214 patients by frozen section (FS) and all blocks of 156 patients by touch imprint cytology (TIC). RESULTS: A total of 1046 SLNs were excised. Overall performance of the assay compared to post-operative histology was accuracy of 91.4 %, sensitivity of 87.5 %, and specificity of 92.9 %. There were no significant differences in assay performance of each center. After a learning curve of about 10 cases, the assay could be performed in a median time of about 35 min. The sensitivity of the assay was similar to the FS (84.9 %, P = 0.885) and was significantly higher than the TIC (70.0 %, P = 0.007) while the specificity of all were comparable. CONCLUSION: The GeneSearch™ Breast Lymph Node Assay is an accurate and rapid intra-operative assay for breast SLNs and it can replace FS and TIC for application.
[Show abstract][Hide abstract] ABSTRACT: To investigate the clinicopathologic and immunohistochemical features as well as the differential diagnoses of the solid variant of mammary adenoid cystic carcinoma with basaloid features.
Clinical and pathological data were collected in four cases of the solid variant of mammary adenoid cystic carcinoma with basaloid features, and microscopic pathological examination and immunohistochemistry EnVision method were performed. The relevant literature was also reviewed.
The four patients were female, with age ranged from 46 - 65 years old (average 56 years) and the maximum tumor diameter ranged from 1.5 to 2.5 cm. Microscopically, the tumors exhibited a predominantly solid architecture with a myxoid or hyalinized stroma. The tumor cells showed moderate to marked nuclear atypia, and a basaloid appearance with scanty cytoplasm and inconspicuous nucleoli, and ≥ 5 mitotic figures per 10 high power fields. Glandular space embedded within tumor islands could be noticed. These spaces were genuine glandular structures and the cells lining these true glandular lumens had more abundant and eosinophilic cytoplasm. Pseudoglandular spaces of cribriform pattern or variable shape were also occasionally seen, and these cysts contained homogenous eosinophilic material. Focal necrosis was found. All cases were negative for ER, PR and HER2. Immunohistochemical staining for CK5/6, CK7 and CK14 was positive in the genuine glandular structures. All cases were positive for CD10, but also positive with varying intensity from weak to strong for vimentin and CD117. Staining for Ki-67 in three patients showed 10% - 50% positive.
The solid variant of mammary adenoid cystic carcinoma with basaloid features is a histologically distinctive and also a rare subset of the mammary adenoid cystic carcinoma. Awareness of its pathological features can help with the diagnosis as well as differential diagnosis. More cases are still needed for accurately assessing the prognosis of this particular tumor.
Zhonghua bing li xue za zhi Chinese journal of pathology 12/2012; 41(12):803-7.
[Show abstract][Hide abstract] ABSTRACT: We assessed the MSKCC nomogram performance in predicting SLN metastases in a Chinese breast cancer population. A new model (the SCH nomogram) was developed with clinically relevant variables and possible advantages. Data were collected from 1,545 patients who had a successful SLN biopsy between March 2005 and November 2011. We validated the MSKCC nomogram in the modeling and validation group. Clinical and pathologic features of SLN biopsy in modeling group of 1,000 patients were assessed with multivariable logistic regression to predict the presence of SLN metastasis in breast cancer. The SCH nomogram was created from the logistic regression model and subsequently applied to 545 consecutive SLN biopsies. By multivariate analysis, age, tumor size, tumor location, tumor type, and lymphovascular invasion were identified as independent predictors of SLN metastasis. The SCH nomogram was then developed using the five variables. The new model was accurate and discriminating (with an AUC of 0.7649 in the modeling group) compared to the MSKCC nomogram (with an AUC of 0.7105 in the modeling group). The area under the ROC curve for the SCH nomogram in the validation population is 0.7587. The actual probability trends for the various deciles were comparable to the predicted probabilities. The false-negative rates of the SCH nomogram were 1.67, 3.54, and 8.20 % for the predicted probability cut-off points of 5, 10, and 15 %, respectively. Compared with the MSKCC nomogram, the SCH nomogram has a better AUC with fewer variables and has lower false-negative rates for the low-probability subgroups. The SCH nomogram could serve as a more acceptable clinical tool in preoperative discussions with patients, especially very-low-risk patients. When applied to these patients, the SCH nomogram could be used to safely avoid a SLN procedure. The nomogram should be validated in various patient populations to demonstrate its reproducibility.
Breast Cancer Research and Treatment 09/2012; 135(3):839-48. · 4.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Conventional procedures for the intraoperative assessment of breast cancer sentinel lymph nodes (SLNs) are frozen section (FS) and touch imprint cytology (TIC). The one-step nucleic acid amplification (OSNA) assay is a novel molecular technique. The aim of this study was to evaluate the optimal approach by comparing OSNA assay, FS, and TIC. Five hundred and fifty-two consecutive patients were enroled from five study centers in China. The SLNs were cut into alternating 2 mm blocks. The odd blocks were tested by the OSNA assay intraoperatively, and the even ones were assessed by postoperative histology (four 4- to 6-μm-thick sections were taken every 200 μm per block). In addition, intraoperative histological assessments were carried out on the even blocks of 211 patients by FS and all blocks of 552 patients by TIC. Overall performance of the assay compared to postoperative histology was: accuracy 91.4%; sensitivity 83.7%; and specificity 92.9%. The sensitivity of the assay was higher than FS (211 patients, 77.6% vs 69.7%; not significant, P = 0.286) and was significantly higher than TIC (552 patients, 83.6% vs 76.2%; P = 0.044). When assessing nodes with micrometastases, the sensitivity of the assay was higher than FS (17 nodes, 47.1% vs 23.5%; not significant, P = 0.289) and was significantly higher than TIC (48 nodes, 62.5% vs 35.4%; P = 0.007). The study indicated that the OSNA assay is an accurate and rapid intraoperative assay for assessing breast SLNs and it can replace FS and TIC for application in general medical practice. The trial was registered as: OSNA assay China Registration Study. Clinical trial registration number: China Breast Cancer Clinical Study Group 001c.
[Show abstract][Hide abstract] ABSTRACT: Rhabdomyosarcoma (RMS) is an uncommon malignancy of the breast. The aim of this study was to summarize its clinicopathologic features and biological behavior.
Five primary or secondary breast RMSs were collected. Their clinicopathological characteristics and all published literature about breast RMS were reviewed. Immunohistochemical study of desmin, myogenic differentiation 1 (MyoD1), myogenin, leukocyte common antigen (LCA), vimentin, cytokeratin (AE1/AE3), E-cadherin, neuron specific enolase (NSE), CD99, chorioallantoic membrane 5.2 (CAM5.2) and epithelial membrane antigen (EMA) expression were performed.
The five patients were all female with ages ranging from 16 to 46 years old (mean, 30 years). Three were metastatic breast RMSs, two embryonal and one solid variant alveolar, with the primary tumor sites the right labium majus, left nasal meatus and nasopharynx, respectively. The other two, one embryonal and one alveolar, were primaries. Grossly, the surgical specimens revealed round or oval, well-demarcated but nonencapsulated masses. Their cut surfaces consisted of homogeneous grayish yellow or white tissue. Microscopically, most tumor cells were poorly differentiated small round, oval or small polygons with eosinophilic cytoplasm. All cases were positive for vimentin, desmin, MyoD1 and myogenin. One embryonal RMS also had a few cells with perinuclear staining of AE1/AE3. The other markers were negative.
Although primary or metastatic RMS in breast was almost confined to young adolescent females, our cases suggested that it can also happen to the middle-aged women. Embryonal RMS has a certain metastatic potential. MyoD1 and myogenin are two useful markers when making differential diagnosis. Axillary lymph node status and age may play a role in the prognosis of primary breast RMS patients.
Chinese medical journal 07/2012; 125(14):2618-22. · 1.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the role of cytopathology in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for lung tumor diagnosis and staging.
Two-hundred consecutive cases of lung tumor with EBUS-TBNA performed during the period from April, 2009 to September, 2010 in Shanghai Cancer Hospital were retrospectively reviewed. The cytologic diagnoses were categorized as non-diagnostic, negative, suspicious and malignant. When available, cell block preparation and immunohistochemistry were performed. On the 22 positive cases diagnosed by on-site evaluation, epidermal growth factor receptor (EGFR) mutation study was carried out.
In the 200 cases of cytology specimens, 122 cases (69.3%) were diagnosed as malignant, 42 cases (23.9%) as benign and 12 cases (6.8%) as suspicious for malignancy. The non-diagnostic rate was 12.0% (24/200). Amongst the 200 cases studied, 140 cases (70.0%) had histologic correlation available (via core biopsy, mediastinoscopic biopsy or surgical excision). The sensitivity and specificity of EBUS-TBNA cytologic diagnoses were 94.4% and 100%, when using histopathologic findings and clinical follow-up data as gold standard. The cell block preparation and immunohistochemistry were useful in subtyping and diagnosis of extrathoracic malignancy. EGFR mutations were detected in 8 cytology samples (36.4%).
EBUS-TBNA is a sensitive and specific tool for diagnosis and staging of lung cancer. The cytology samples can be used for further ancillary investigations including cell block preparation, immunohistochemistry and molecular studies.
Zhonghua bing li xue za zhi Chinese journal of pathology 01/2012; 41(1):44-7.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate factors that could possibly affect the outcome of patients failing to achieve pathological complete response (pCR) after anthracycline-containing neoadjuvant chemotherapy (NCT) for breast cancer, and built a prognostic model to predict patients' outcome.
Data from 199 stage II-III breast cancer patients who failed to achieve pCR after NCT were used. Variables at baseline and at surgery (age, menopausal status, tumour size, grade, histotype, node status, vascular invasion, ER, PR, HER-2, Cathepsin D, P53, Topo-IIα, Nm-23, Bcl-2, BAX, MDR, GSTN, PS2, P27, Cyclin D1 and Ki-67) were investigated.
Tumour marker Ki-67, Cathepsin D status and number of positive lymph nodes at surgery were significant prognostic factors in multivariate analysis for both DFS and OS. According to our prognostic model, the 5-year DFS rates in low, intermediate-low, intermediate-high and high-risk groups were 94%, 65%, 43% and 28%, respectively (log-rank test P < 0.001). The 5-year OS rates in these four groups were 94%, 84%, 66% and 34%, respectively (log-rank test P < 0.001).
Our prognostic model could easily discriminate patients with different risks of experiencing an event or death, which could allow physicians to tailor treatment strategies specifically and individually.
Journal of Surgical Oncology 11/2011; 105(6):577-85. · 2.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the two-tier system for the grading of ovarian serous carcinomas, and to analyze Pax2, p53, Ki-67 protein expression and their prognostic values for low- and high-grade ovarian serous carcinomas.
A total of 38 cases of low-grade and 100 cases of high-grade ovarian serous carcinomas were selected based on the two-tier grading system. Immunohistochemistry was used to detect Pax2, p53 and Ki-67 protein expression in all cases. Correlation of the two-tier system with immunohistochemical results and prognostic parameters were performed.
(1) The overall survival, disease-free survival and 5-year survival rates were significantly higher in the low-grade serous carcinoma cases than in the high-grade cases (P < 0.05). (2) Significant differences in protein expressions were found between the low- and high-grade serous carcinomas. The high-grade serous carcinomas had a significantly higher expression level of p53 (55.0% vs 13.2%, P < 0.05) and Ki-67 (42.1% vs 13.7%, P < 0.05), while low-grade carcinomas had a significantly higher expression level of Pax2 (65.8% vs 13.0%, P < 0.05). (3) Pax2 positive cases had a significantly better overall survival and 5-year survival rates than Pax2 negative cases (P < 0.05). The expressions of p53 and Ki-67 were found to have little correlation with overall survival and disease-free survival (P > 0.05).
The two-tier system for the grading of ovarian serous carcinomas has a good prognostic value. There are significantly differences in expressions of Pax2, p53 and Ki-67 between low- and high-grade ovarian serous carcinomas. Compared with p53 and Ki-67, Pax2 is likely a better prognostic indicator for ovarian serous carcinoma.
Zhonghua bing li xue za zhi Chinese journal of pathology 08/2011; 40(8):511-6.
[Show abstract][Hide abstract] ABSTRACT: To study the clinicopathologic features, immunophenotypes and differential diagnoses of invasive carcinoma arising in breast microglandular adenosis (MGACA).
Clinical and pathologic findings of 3 cases of MGACA were analyzed by histomorphology and immunohistochemical staining of CK7, S-100 protein, ER, PR, HER2, SMA, MSA, p63 and PAS. Literatures were reviewed.
(1) Histologically, 3 tumors all showed a spectrum of glandular proliferations ranging from microglandular adenosis (MGA) to atypical microglandular adenosis (AMGA) to in situ carcinoma (DCIS) to invasive carcinoma. The invasive carcinoma component was ductal in case 1, and matrix-producing in case 2 and case 3. (2) All epithelial cells in MGA, AMGA, DCIS and MGACA were positive for CK7 and S-100 protein, but were negative for ER and HER2. PR was negative in case 1 and case 2 but was low positive in case 3. Myoepithelial cell differentiation was not demonstrated in MGA, AMGA, DCIS and MGACA by immunohistochemical staining for SMA, MSA or p63. PAS staining showed the presence of basement membrane in MGA, AMGA and DCIS, except MGACA.
MGACA is an extremely rare tumor of the breast and has distinct morphological and immunohistochemical features. Further studies are needed to evaluate the clinical behavior of this rare neoplasm.
Zhonghua bing li xue za zhi Chinese journal of pathology 07/2011; 40(7):471-4.
[Show abstract][Hide abstract] ABSTRACT: Accurate intraoperative diagnosis of sentinel node metastasis enables the surgeon to make an immediate decision to proceed to axillary lymph node dissection (ALND), thereby avoiding the economic and psychological costs of a second operation. The present study aimed to evaluate the clinical value of touch imprint cytology (TIC) and investigate the potential factors associated with misdiagnosis. A total of 366 patients with Tis-T2 breast carcinoma were included after undergoing successful sentinel lymph node biopsy (SLNB). TIC was routinely performed intraoperatively, and the results were compared with definitive histological assessments of serial sections (SS) with hematoxylin and eosin (H&E) staining. A total of 992 SLNs from 366 patients were used in the study. Based on the final histological diagnosis, the sensitivity, specificity and overall accuracy of TIC was 76.6, 98.8 and 92.3%, respectively, on a per patient basis, and 79.9, 98.9 and 96.1%, respectively, on a per node basis. TIC was significantly more sensitive for macrometastasis than micrometastasis (80.0 vs. 28.6%, P<0.01). Of 9 total 'false positives', 3 were due to micrometastasis which were not identified by serial section with H&E staining, 4 were actual false-positives which were due to interpretation error, and 2 were due to sampling error. The majority of the false-negatives (28 of 30 SLNs) were due to micrometastasis in the SLNs (sampling error). In conclusion, TIC is feasible for clinical use and is able to detect macrometastasis in the SLNs of early stage invasive breast cancer patients with an acceptable accuracy while its ability to detect micrometastasis is limited.
[Show abstract][Hide abstract] ABSTRACT: Accurate intraoperative diagnosis of sentinel lymph node (SLN) metastases enables the selection of patients for axillary lymph node dissections during the same operation, reducing the need for a second operation. The present study aimed to prospectively compare the GeneSearch(TM) Breast Lymph Node (BLN) Assay with touch imprint cytology (TIC) for intraoperative evaluation of SLNs.
SLNs were sectioned in 1.5 - 3.0 mm pieces. TIC was performed on all pieces and the BLN Assay and postoperative histology evaluations were performed on different alternating node pieces. Overall performance of the BLN Assay was compared with that of TIC relative to the postoperative histology results.
A total of 90 patients enrolled in the study. Complete intraoperative data for both the BLN Assay and TIC were collected in 86 patients. The sensitivity, specificity, and overall accuracy of the BLN Assay were 82%, 97%, and 92%, respectively on a per patient basis compared with those of TIC which were 67%, 100%, and 90%.
Performance of the BLN Assay was superior to that of TIC and the additional application of TIC did not help improve the total sensitivity and accuracy of the intraoperative assessment. The existence of ectopic breast tissue might be a possible cause of false positive for the BLN assay. In addition, the BLN Assay complements histopathology assessment and can minimize sampling error without increasing pathologists' workload.
Chinese medical journal 02/2011; 124(4):491-7. · 1.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the clinical value of GeneSearch(TM) BLN Assay as an intra-operative diagnostic method of sentinel lymph node (SLN) for breast cancer patients.
A total of 479 consecutive patients from six centers were involved in this prospective study. The SLNs were identified, dissected and then sectioned along the short axis into multiple blocks. The odd blocks were tested intra-operatively by the above-mentioned assay and the even blocks assessed post-operatively by histopathologic examination. The 4 - 6 µm thick stepwise sectioning permanent HE slides were prepared every 150 µm and one block yielded 6 slides. In addition, the even blocks of 136 patients were prepared for frozen section (FS) and all blocks of 156 patients evaluated intra-operatively by touch imprint cytology (TIC).
In the node basis analysis, its accuracy, sensitivity, specificity, positive predict value (PPV) and negative predict value (NPV) were 93.0%, 85.6%, 94.6%, 76.6% and 96.9% respectively. Its sensitivity was similar to that of FS (84.9%, P = 0.885) and significantly higher than that of TIC (70.0%, P = 0.007). When assessing nodes with macro-metastases, its sensitivity was similar to that of FS (93.6% vs 95.6%, P = 0.558) and significantly higher than that of TIC (93.6% vs 80.9%, P = 0.011). When assessing nodes with micro-metastases, it had a higher sensitivity than that of FS (57.5% vs 44.4%, P = 0.356) and TIC (57.5% vs 30.8%, P = 0.094). In the patient basis analysis, the accuracy, sensitivity, specificity, PPV and NPV were 91.4%, 87.5%, 92.9%, 81.8% and 95.3% respectively. Its sensitivity was similar to that of FS (84.5%, P = 0.576) and significantly higher than that of TIC (75.0%, P = 0.049). After adjustment, it had the accuracy, sensitivity, specificity, PPV and NPV of 91.7%, 83.5%, 95.2%, 88.3% and 93.0% respectively. Its sensitivity was higher than that of FS (72.1%, P = 0.054) and significantly higher than that of TIC (66.7%, P = 0.011). The two had no significant difference in the sensitivity and specificity. After a learning curve of around 10 cases, it could be performed in a median time of around 35 min. The threshold cycle time values of MG and CK-19 were 36 and 31 respectively. The type of metastases could be estimated approximately according to the cycle time values. The cycle time values of MG under 33 indicated SLN macro-metastases and those of 33-36 denoted micro-metastases. The values of CK-19 under 29 indicated SLN macro-metastases and those of 29-31 denoted micro-metastases.
As an accurate and rapid intra-operative assay for breast sentinel lymph nodes, the GeneSearch(TM) BLN Assay may replace FS and TIC in general medical practice.
[Show abstract][Hide abstract] ABSTRACT: to evaluate the application of GeneSearch(TM) breast lymph node assay in intraoperative detection of metastases in sentinel lymph node (SLN) from breast cancer patients.
a total of 225 SLN from 88 patients was prospectively studied. Each SLN was cut into 2 mm slabs which were examined by intraoperative imprint cytology (IIC) first, followed by GeneSearch assay and post-operative serial sectioning. GeneSearch used real-time fluorescence quantitative RT-PCR technology to detect the expression of CK19 and mammaglobin in SLN. The results of GeneSearch assay were correlated with those of IIC and post-operative serial sectioning.
amongst the 88 cases studied, 225 SLNs were found, and obvious metastatic carcinoma cells were identified in 27 SLNs and micrometastasis in 9 SLNs. One hundred and eight-nine SLNs were considered as "negative" (with "isolated tumor cells" present in 5 SLNs). The turn-around time of intraoperative GeneSearch assay ranged from 35 to 45 minutes (mean = 40 minutes). The concordance rate between GeneSearch assay and post-operative serial sectioning was 95.6% (215/225), with a sensitivity of 86.1% (31/36), compared with 94.7% (213/225) and 72.2% (26/36) respectively for IIC. The size of metastatic foci correlated with the Ct value of CK19 and mammaglobin (P < 0.01).
GeneSearch assay for intraoperative detection of metastase in SLN has a satisfactory performance and demonstrates a relatively higher sensitivity than IIC. The potential clinical application still requires further evaluation of larger number of cases.
Zhonghua bing li xue za zhi Chinese journal of pathology 11/2010; 39(11):729-33.