Total Tumor Load of mRNA Cytokeratin 19 in the Sentinel Lymph Node as a Predictive Value of Axillary Lymphadenectomy in Patients with Neoadjuvant Breast Cancer.

Karla B Peña,Alba Cochs,Amillano Kepa,Francesc Riu,Josep Gumà,David Parada

doi:10.3390/genes12010077

Karla B Peña, Alba Cochs + Show 4 more

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https://doi.org/10.3390/genes12010077

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Abstract

Although sentinel lymph node biopsy (SLNB) has proved to be able to diagnose axillary lymph node status safely and reliably, there is still not enough evidence to suggest that it can be used in patients who have undergone neoadjuvant chemotherapy (NAC) for lymph node-sparing surgery. The present study used molecular approaches to determine whether SLNB can be reliably used in patients who have been treated with NAC before SLN surgery, and whether the total tumor load of the SLN can be used as a predictive factor in axillary lymphadenectomy (ALD). We used one-step nucleic acid amplification (OSNA) to analyze a total of 111 consecutive patients who presented operable invasive breast carcinomas and who had been treated with NAC. SLN was positive in 55 patients and the identification rate was 100%. In 9 of these 55 patients, ALD showed that other lymph nodes were also involved. In all of the other 46 patients, the only lymph node to be identified as positive was SLN. Metastasis was not found in any of the axillary lymph nodes in the isolated tumor cell group. The total tumor load, defined as the amount of cytokeratin 19 mRNA copy numbers in all positives SLN (copies/µL), showed three risk groups related to the possibility of positive non-sentinel nodes. OSNA is a diagnostic technique that is highly sensitive, specific, and reproducible and it can be used to analyze sentinel lymph nodes after NAC. Total tumor load may be able to help predict additional metastases in axillary lymphadenectomy.

Highlights

It has been pointed out that there is no need for the axillary lymphadenectomy (ALD) in patients with low burdens of axillary disease [2,3,4], especially in those who only have micrometastatic disease [4], or if there are only one or two lymph nodes with macrometastases [4]
Neoadjuvant chemotherapy (NAC) has the following advantages: it turns an initial non-surgical breast cancer into one that is operable, it increases the number of conservative surgeries, it evaluates in vivo tumor sensitivity to chemotherapy treatment, it initiates early systemic treatment and it may be useful for translational research
The administration of neoadjuvant chemotherapy was carried out following the protocols of our hospital and at the discretion of the medical oncologist

Summary

Introduction

Sentinel lymph node biopsy (SLNB) is a standard surgical procedure that can be used to diagnose axillary lymph node status in patients with clinically node-negative breast cancer. Neoadjuvant chemotherapy (NAC) is the standard treatment in patients with locally advanced or inflammatory breast cancer, and there is evidence to support its usefulness in the initial stages of the disease [5,6,7,8]. NAC is indicated in patients with tumors of 30 mm or even smaller, when conservative surgery is not possible. NAC has the following advantages: it turns an initial non-surgical breast cancer into one that is operable, it increases the number of conservative surgeries, it evaluates in vivo tumor sensitivity to chemotherapy treatment, it initiates early systemic treatment and it may be useful for translational research

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