RT–PCR technique for the intra-operative assessment of breast sentinel lymph nodes – Is this the way forward?

• DOI: 10.5430/jst.v1n2p56
• Publication Date: 2011-10-19T10:53:33Z
• Authors: Santosh Kumar Som...; Alistair Ironside; Rachel McCarthy; Stephen Davison; Tim Davidson; Nuala McDermott; Mohammed Keshtgar
• Keywords: Mammaglobin; Micrometastasis

Background Sentinel lymph node biopsy (SLNB) is the current standard of care for lymphatic staging in early breast cancer patients. The combination a SLNB with an intra-operative diagnosis enables single staged procedure, avoiding delayed axillary dissection (ALND) positive conventional pathological techniques are resource intensive, require expert personnel and not routinely used many units. Methods GeneSearch™ BLN assay RT-PCR technique calibrated to detect SLN metastases >0.2mm. It designed 2 clinically validated genes Mammaglobin (MG) Cytokeratin – 19 provide rapid diagnosis.The identification was by combined using radiocolloid patent blue dye. excised SLNs were sliced their short axis at intervals 1.5 mm mm. sections numbered alternate processed histopathology assay.The study conducted phases. first phase evaluate accuracy feasibility as diagnostic test. second real time application results inform decision regarding immediate ALND. Results This prospective comprised 166 patients 164 females male 86 had left cancer, 75 right 5 synchronous bilateral cancers. A total 171 procedures done 271 average 1.58 per procedure. Only 266 included analysis invalid. All underwent compared final histology. recorded on patient basis . initial validation 53 performed 92 from these sensitivity specificity 100% 87.1% respectively. On basis, 93.7% 92.1% processing 1 during this 31.6 min 47.4 SLNs. During 2nd study, actioning phase, 113 recruited analysing 174 92.3% 94.3% 94.1% 96.4% turn around significantly better 21.5 32.6 Combining both phases, 95% 92% 94% 94.9% Conclusions reliable detection relevant metastases. good alternative histopathological tests but comparably less specificity.