Methods of axillary staging How quick?
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1 Methods of axillary staging How quick? One step nucleic acid amplification (OSNA) for the sentinel node YLJ Vissers, surgical oncologist Atrium-Orbis Medical Center, Heerlen-Sittard
2 no conflict of interest
3 Traditional sentinel node analysis sliced for microscopic analysis Procedure takes 2 days Delays diagnosis No intra-operative analysis Remaining material is not analyzed False negatives No standardisation Inter-observer variation
4 patient s requests Reduction of waiting time for diagnoses Reduction of the number of recalls for second surgical interventions
5 Quick tests sentinel node sensivity 63% sensivity 73% Liu LC, Lang JE, Lu Y, et al. Intraoperative frozen section analysis of sentinel lymph nodes in breast cancer patients. Cancer. 2011;117:250 8.
6 Molecular analysis Measures amount of CK19 mrna Result as (negative) (micro) (macro) 40 minutes for definitive diagnosis
7 standardisation speed complete node analysed
8
9 Comments Not all tumours contain CK19 test beforehand Loss histology keep central slice More micrometastases detected Recklessly performed ALND s with every positive result prior review axillary treatment in pre-operative MDT
10 Users
11 Atrium-Orbis experience Pilot patients 65 lymph nodes 65 OSNA samples Result as (-) (+) (++) by courtery of H.Plasschaert, 2013
12 Results pilot Tissue allocation bias OSNA by courtery of H.Plasschaert, 2013
13 Business case
14 Indication pre-operatively type of surgery CK19 present vascular invasion BR grade tumour size Nortier JWR, Smorenburg CH, Van Dalen T, Van der Sangen MJC. Compendium behandeling van het mammacarcinoom, 2015
15 during surgery
16 Results 12 mastectomy 27 breast conserving 6 tissue expander 1 after NAC 2 macro 2 micro 7 micro 3 macro 2 ALND 2 ALND
17 10 minutes 15 minutes minutes 64 minutes
18 post-operatively 0 recalls 0 secondary ALND 5 adjuvant axillary radiotherapy 6 no adjuvant axillary treatment
19 Patient opinions Er is niets erger dan wachten op de uitslag. De eerste keer moest ik een week wachten. De spanning is ondraaglijk. Nachten lang wakker liggen. Dat was vreselijk. Ik ben echt blij met de nieuwe techniek. Het is een groot verschil met mijn eerdere ervaring. Het levert veel minder spanning op. Toen ik bijkwam uit de narcose wist ik direct wat de uitslag was. Niet meer wachten en één spanningspiek minder. Dat is voor mij het grootste pluspunt van de nieuwe werkwijze.
20 Summary Atrium-Orbis experience Intra-operative results within reasonable time frame No recalls in postoperative MDT Advantages mainly in mastectomy, direct reconstructions Patients relieved
21
22 Future?
23 Discarded if sentinel procedure or ALND becomes abandoned? Future tool for predicting which patients benefit from ALND?
24 Conclusion One step nucleic acid amplification (OSNA) for the sentinel node Reliable, quick method for sentinel node analysis Reduces need for secondary surgery direct reconstruction with prosthesis mastectomy Reduces waiting time for definite diagnosis May have future implication as prediction model for extensive nodal metastasis
25 dept.surgery J van Bastelaar L van Driel E van Haaren C Heymans F Jorna C Scheeren Acknowledgements dept.plastic surgery D Booi M Meesters T vmulken dept.pathology S Corvers K Machielsen P Sastrowijoto R Smeets W Vos H Plasschaert (currently Antwerp) MAASTRO dept.oncology F Erdkamp R vkampen F Peters M Portz dept.radiology A Muller M Osinga H vdpol
26 Molecular analysis upstaged 13% (52 of 394) node-negative patients. At mean follow-up of 7 years, these patients had a significantly lower distant recurrence-free survival Patients with N0(mol+) disease are 3.4 times more likely to experience relapse than PCRnegative patients (P =.001) Verbanac K.M., Min C.J., Mannie A.E., et al: Long-term follow-up study of a prospective multicenter sentinel node trial: molecular detection of breast cancer sentinel node metastases. Ann Surg Oncol 2010; 17(Suppl 3):
27
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