Sentinel lymph node biopsy with one‑step nucleic acid assay relegates the need for preoperative ultrasound‑guided biopsy staging of the axilla in patients with early stage breast cancer

Inua,Bello; Fung,Victoria; Al‑Shurbasi,Nour; Howells,Sarah; Hatsiopoulou,Olga; Somarajan,Praveen; Zardin,Gregory J.; Williams,Norman R.; Kohlhardt,Stan

doi:10.3892/mco.2021.2213

Sentinel lymph node biopsy with one‑step nucleic acid assay relegates the need for preoperative ultrasound‑guided biopsy staging of the axilla in patients with early stage breast cancer

Authors:
- Bello Inua
- Victoria Fung
- Nour Al‑Shurbasi
- Sarah Howells
- Olga Hatsiopoulou
- Praveen Somarajan
- Gregory J. Zardin
- Norman R. Williams
- Stan Kohlhardt
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Affiliations: Department of Breast, Plastic and Reconstructive Surgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK, Department of Breast Screening and Breast Imaging, Royal Hallamshire Hospital, Sheffield S10 2JF, UK, Department of Histopathology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK, Surgical and Interventional Trials Unit, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London W1W 7JN, UK
Published online on: January 21, 2021 https://doi.org/10.3892/mco.2021.2213
Article Number: 51
Copyright: © Inua et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Avoiding axillary node clearance in patients with early stage breast cancer and low‑burden node‑positive axillary disease is an emerging practice. Informing the decision to adopt axillary conservation is examined by comparing routine preoperative axillary staging using ultrasound (AUS) ± AUS biopsy (AUSB) with intraoperative staging using sentinel lymph node biopsy (SLNB) and a one‑step nucleic acid cytokeratin‑19 amplification assay (OSNA). A single‑centre, retrospective cohort study of 1,315 consecutive new diagnoses of breast cancer in 1,306 patients was undertaken in the present study. An AUS ± AUSB was performed on all patients as part of their initial assessment. Patients who had a normal ultrasound (AUS‑) or negative biopsy (AUSB‑) followed by SLNB with OSNA ± axillary lymph node dissection (ALND), and those with a positive AUSB (AUSB+), were assessed. Tests for association were determined using a χ² and Fisher's Exact test. A total of 266 (20.4%) patients with cT1‑3 cN0 staging received 271 AUSBs. Of these, 205 biopsies were positive and 66 were negative. The 684 patients with an AUS‑/AUSB‑assessment proceeded to SLNB with OSNA. AUS sensitivity and negative predictive value (NPV) were 0.53 [0.44‑0.62; 95% confidence interval (CI)] and 0.58 (0.53‑0.64, 95% CI), respectively. Using a total tumour load cut‑off of 15,000 copies/µl to predict ≥2 macro‑metastases, the sensitivity and NPV for OSNA were 0.82 (0.71‑0.92, 95% CI) and 0.98 (0.97‑0.99, 95% CI) (OSNA vs. AUS P<0.0001). Of the AUSB+ patients, 51% had ≤2 positive nodes following ALND and were potentially over‑treated. Where available, SLNB with OSNA should replace AUSB for axillary assessment in cT1‑2 cN0 patients with ≤2 indeterminate nodes seen on AUS.

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