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Assessment of suitability of the one step nucleic acid amplification (OSNA) assay as an intraoperative procedure for detection of metastasis in sentinel lymph nodes of breast cancer
  1. Ana Richelia Jara-Lazaro1,
  2. Ilyana Huda Mohamed Hussain1,
  3. Aye Aye Thike1,
  4. Chow Yin Wong2,
  5. Gay Hui Ho3,
  6. Wei Sean Yong3,
  7. Kong Wee Ong3,
  8. Preetha Madhukumar3,
  9. Benita Kiat Tee Tan2,
  10. Chung Lie Oey2,
  11. Jacqueline Siok Gek Hwang1,
  12. Puay Hoon Tan1
  1. 1Department of Pathology, Singapore General Hospital, Singapore, Singapore
  2. 2Department of General Surgery, Singapore General Hospital, Singapore, Singapore
  3. 3Department of Surgical Oncology, National Cancer Center, Singapore, Singapore
  1. Correspondence to Dr Puay Hoon Tan, Department of Pathology, Singapore General Hospital, 20 College Road, Academia, Level 7, Diagnostics Tower, Singapore 169856, Singapore; tan.puay.hoon{at}sgh.com.sg

Abstract

Aim We aimed to assess the one step nucleic acid amplification (OSNA) assay as an intraoperative method in comparison with frozen sections (FS) for detection of metastasis in sentinel lymph nodes (SLNs) of breast cancer.

Method 100 SLNs from patients with breast carcinoma were enrolled within a 3-month period. Alternate 2 mm node slices were subjected to routine FS, and later to permanent histology, and the rest for automated molecular detection of CK19 mRNA using OSNA. FS and OSNA findings were compared with permanent histology results. Difference in turnaround time was also noted.

Results With permanent histology as gold standard, OSNA was discrepant in 8 of 98 (3 false negative, 5 false positive) included SLNs whereas FS had 2 false negative cases. FS had higher sensitivity (89%, p=<0.001), specificity (100%, p=0.001) and concordance rate (98%) than OSNA (83%, 94% and 92%, respectively). FS showed almost perfect agreement (κ=0.929) whereas OSNA showed substantial agreement (κ=0.740) when compared with permanent histology. OSNA turnaround time was twice longer (mean of 47.7 min) than FS.

Conclusions Automation of SLN assessment using OSNA is a potentially useful intraoperative diagnostic tool with acceptable accuracy. Discordant findings in this study may be due to sampling allocation. Since OSNA is more time-consuming, its practical advantage over routine FS requires further study in view of current technical workflow considerations.

  • BREAST CANCER
  • MOLECULAR PATHOLOGY
  • SENTINEL NODE

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