TY - JOUR
T1 - One-step nucleic acid amplification for intraoperative analysis of sentinel lymph node in papillary thyroid carcinoma
AU - Felip, Carmela Iglesias
AU - Llopis, Carles Zafon
AU - Temprana-Salvador, Jordi
AU - García-Burillo, Amparo
AU - Créixams, Xavier Serres
AU - Busquet, Enric Caubet
AU - Bielsa, Isabel Roca
AU - Manteca, Jordi Mesa
AU - Conesa, Joan Castell
AU - López-Barajas, José Manuel Fort
AU - Pujol-Borrell, Ricardo
AU - Cajal Agüeras, Santiago Ramon
AU - López, Oscar González
PY - 2019/1/1
Y1 - 2019/1/1
N2 - © 2019 European Society of Endocrinology Printed in Great Britain Published by Bioscientifica Ltd. Objective: Lymphadenectomy in papillary thyroid carcinoma (PTC) is controversial. It is indicated whenever metastases have been proven before or during surgery and as a prophylactic treatment in high-risk patients. However, 30–50% of cN0 patients become pN1 postoperatively. In PTC, selective-sentinel-lymph-node-biopsy (SLNB) with conventional intraoperative analysis is 8% false negative. One-step nucleic acid amplification (OSNA) is a molecular technique which allows real-time detection of mRNA encoding for cytokeratin 19. OSNA has been introduced in intraoperative analysis of several tumors to reduce false-negative rates and distinguish micrometastasis from macrometastasis. Our objective was to evaluate the impact of the introduction of OSNA in the intraoperative evaluation of the sentinel node (SN) in PTC. Design: We analyzed a series of 35 patients subjected to SLNB. Methods: All the dissected nodes, SN and non-SN, were evaluated with OSNA and cytology. Results: We obtained a total of 110 SN. SLNB proved positive in 14 patients (40%) with cytology and in 23 (65.7%) with OSNA (P < 0.001). In the 29 patients with subsequent lymphadenectomy we obtained 360 lymph nodes ((52 positive in cytology (14.4%) and 107 in OSNA (29.7%)). Lymphadenectomy proved positive in 16 patients according to cytology (55%) and in 24 according to OSNA (83%) (P = 0002). The majority of patients with micrometastasis in SN showed only micrometastasis in lymphadenectomy. Conclusions: The present study shows selective-sentinel-lymph-node-biopsy with one-step nucleic acid amplification technique to be feasible in papillary thyroid carcinoma. The quantitative nature of one-step nucleic acid amplification paves the way toward a more personalized surgical approach, limiting lymphadenectomy to patients with intraoperative evidence of macrometastasis in the sentinel node.
AB - © 2019 European Society of Endocrinology Printed in Great Britain Published by Bioscientifica Ltd. Objective: Lymphadenectomy in papillary thyroid carcinoma (PTC) is controversial. It is indicated whenever metastases have been proven before or during surgery and as a prophylactic treatment in high-risk patients. However, 30–50% of cN0 patients become pN1 postoperatively. In PTC, selective-sentinel-lymph-node-biopsy (SLNB) with conventional intraoperative analysis is 8% false negative. One-step nucleic acid amplification (OSNA) is a molecular technique which allows real-time detection of mRNA encoding for cytokeratin 19. OSNA has been introduced in intraoperative analysis of several tumors to reduce false-negative rates and distinguish micrometastasis from macrometastasis. Our objective was to evaluate the impact of the introduction of OSNA in the intraoperative evaluation of the sentinel node (SN) in PTC. Design: We analyzed a series of 35 patients subjected to SLNB. Methods: All the dissected nodes, SN and non-SN, were evaluated with OSNA and cytology. Results: We obtained a total of 110 SN. SLNB proved positive in 14 patients (40%) with cytology and in 23 (65.7%) with OSNA (P < 0.001). In the 29 patients with subsequent lymphadenectomy we obtained 360 lymph nodes ((52 positive in cytology (14.4%) and 107 in OSNA (29.7%)). Lymphadenectomy proved positive in 16 patients according to cytology (55%) and in 24 according to OSNA (83%) (P = 0002). The majority of patients with micrometastasis in SN showed only micrometastasis in lymphadenectomy. Conclusions: The present study shows selective-sentinel-lymph-node-biopsy with one-step nucleic acid amplification technique to be feasible in papillary thyroid carcinoma. The quantitative nature of one-step nucleic acid amplification paves the way toward a more personalized surgical approach, limiting lymphadenectomy to patients with intraoperative evidence of macrometastasis in the sentinel node.
KW - Adenocarcinoma, Papillary/genetics
KW - Adult
KW - Female
KW - Humans
KW - Lymph Node Excision
KW - Lymphatic Metastasis/genetics
KW - Male
KW - Middle Aged
KW - Nucleic Acid Amplification Techniques/methods
KW - Sentinel Lymph Node Biopsy
KW - Sentinel Lymph Node/pathology
KW - Thyroid Neoplasms/genetics
UR - http://www.mendeley.com/research/onestep-nucleic-acid-amplification-intraoperative-analysis-sentinel-lymph-node-papillary-thyroid-car
U2 - 10.1530/EJE-18-0624
DO - 10.1530/EJE-18-0624
M3 - Article
C2 - 30400049
SN - 0804-4643
VL - 180
SP - 21
EP - 29
JO - European Journal of Endocrinology
JF - European Journal of Endocrinology
ER -