Abstract
Reverse-transcription polymerase chain reaction (RT-PCR) is used to detect CK19 mRNA in sentinel lymph node biopsy (SLNB) tissues from breast cancer patients. We examined whether CK19 mRNA in peripheral blood is predictive of non-sentinel lymph node (nSLN) metastasis. Breast cancer cases diagnosed with clinical stage cT1–3cN0 and registered in our medical biobank were identified retrospectively. This study then included 120 breast cancer cases treated at Zhejiang Cancer Hospital from Aug 2014 to Aug 2015, including 60 SLN-positive and 60 SLN-negative cases. CK19 mRNA levels in peripheral blood samples were assessed using RT-PCR prior to tumor removal. During surgery, if SLNB tissue showed evidence of metastasis, axillary lymph node dissection (ALND) was performed. No ALND was performed if SLNB and nSLN tissues were both negative for metastasis. CK19 expression was higher in nSLN-positive patients than in nSLN-negative patients (p < 0.05). Logistic regression indicated that lymphatic vessel invasion and CK19 levels were predictive of nSLN status (p < 0.05). The area under the ROC curve for CK19 was 0.878 (p < 0.05). We conclude that high CK19 levels in peripheral blood may independently predict nSLN metastasis in breast cancer patients.
Highlights
Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females worldwide, with an estimated 1.7 million cases annually [1]
We examined whether cytokeratin 19 (CK19) mRNA in peripheral blood is predictive of non-sentinel lymph node metastasis
There were no significant differences in age or expression of human epidermal growth factor receptor-2 (HER2), estrogen receptor (ER) and progesterone receptor (PR) between non-sentinel lymph node (nSLN) negative and positive patients
Summary
Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females worldwide, with an estimated 1.7 million cases annually [1]. In more than half of these patients, histologic evaluation of all removed axillary tissue reveals that the SLN was the only lymph node showing evidence of metastasis [2,3,4]. Recent years have seen a steep increase in the development of models predicting the probability of non-SLN (nSLN) metastasis in SLNpositive breast cancer patients [6,7]. Such predictive models may provide evidence-based input for decisionmaking by estimating an individual patient’s risks and benefits with regards to specific therapeutic options, such as ALND [5]
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