bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative intra-operative RT-PCR assay predicts size of sentinel node metastases.
Authors: Blumencranz P , Pieretti M , Asad H , Zanchi A 
Published: December 2010

Abstract
Abstract #1002
The GeneSearch™ Breast Lymph Node (BLN) Assay (Veridex, LLC) has been FDA approved to detect metastases &gt; 0.2 mm in the sentinel lymph nodes (SLNs) of breast cancer patients and has been in clinical use in our institute for 11 months. This assay gives a qualitative (negative/positive) result by applying cutoff values to the cycle times (Ct) of the two mRNA markers analyzed: mammaglobin (MG) (cutoff value = 31 Cts) and cytokeratin 19 (CK19) (cutoff value = 30 Cts). This is the first study to evaluate if the quantitative Ct values of MG and CK19 can be used to estimate probable size of nodal metastases.&#x2028; To date 184 patients have been tested using the BLN Assay during its clinical use at Morton Plant Hospital. An additional 172 patients were tested with the BLN Assay at our institute during investigational studies. In both cases, the SLNs of breast cancer patients were divided into ∼2 mm pieces. Alternating pieces were homogenized and were processed intra-operatively. The other pieces of the SLN were used for permanent section H&E analysis. The patient was considered H&E positive when a metastasis &gt; 0.2 mm was identified. During clinical use, same-surgery complete axillary dissection was performed when the assay was positive (n = 34).&#x2028; Performance of the assay's qualitative result against permanent section H&E on adjacent node pieces was similar for the two groups (total N = 356), for a total sensitivity of 96% (81/84), specificity of 93% (254/272), and overall agreement of 94%. The marker Ct values correlated with metastases size as determined by H&E in adjacent node pieces (r = 0.74 for MG and 0.72 for CK19, p &lt; .0001). The lower the Ct values, the greater the likelihood of macrometastases reported by H&E, as described in Table 1. For example if CK19 is &lt;21.0 and MG is &lt; 25.0, there is 100% chance for H&E positivity in the SLNs, with the majority being macrometastases.&#x2028; &#x2028; Additionally, BLN Assay Ct values in the SLN were predictive of metastases in the non-SLN nodes. For example, of the 12 patients who had a SLN with CK19 &lt; 24 Cts, 9 (75%) had H&E positive non-SLNs. For the same 12 patients, SLNs were H&E positive (5 macrometastases, 5 micrometastases, and 2 reported as &gt; 0.2 mm).&#x2028; The BLN Assay's high intra-operative qualitative performance minimizes the need for second surgeries for complete axillary dissections. Results from this investigational study examining the marker Ct values suggest that the assay may provide valuable individual tumor volume data intra-operatively or post-operatively.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1002.
Intraoperative molecular sentinel lymph node analysis with OSNA: multicentre prospective UK evaluation.
Authors: Kissin MW , Snook KL , Layer GT , Jackson P , de Vries CS , Shousha S , Sinnett HD , Singhal H , Nigar E , Cunnick G , Chia Y 
Published: December 2010

Abstract
Abstract #1003
Introduction: Rapid intraoperative molecular analysis of sentinel lymph nodes (SLNs) in breast cancer (BC) patients has the advantage of providing the surgeon with an immediate automated result, without the opinion of a consultant histopathologist, allowing axillary dissection to proceed in SLN positive patients. We undertook a multicentre, prospective evaluation of the OSNA system (One Step Nucleic Acid Amplification) for molecular analysis, to evaluate this new diagnostic technique's accuracy and feasibility for use in our hospital system. This abstract reports our 'Phase 2 - Intraoperative' experience.&#x2028; Method: Four study centres, both district general and major teaching hospitals took part in the evaluation. SLNs from breast cancer patients were excised using standard surgical techniques. Fresh SLNs were defatted and cut into 4 x 1 or 2mm slices depending on size and weight. Alternate slices underwent lysate preparation and immediate OSNA molecular analysis (detection and amplification of CK19 mRNA); remaining slices were processed for permanent section - intensive haematoxylin & eosin and immunohistochemistry (CK19 and AE1/AE3) examination (25μm multistep sections, 5 levels). OSNA results were correlated with final histopathology findings. Processing times were also recorded. No clinical decision was made based on the intraoperative OSNA result.&#x2028; Results: 396 lymph node samples were included in the analysis. Concordance with histopathology was 96.2% overall with all sites reaching concordance &gt;95%. Overall sensitivity was 91.5%, specificity 97.2%, positive predictive value 87.7%, negative predictive value 98.1%. Concordance of OSNA with histopathology for lobular carcinoma (34 SLN samples) was &gt;95%. There were 14 cases of tissue allocation bias confirmed on repeated molecular and histology testing that were excluded from overall results. Minimum time to reach a result on a single node was 22 minutes.&#x2028; Conclusion: The OSNA molecular system for SLN diagnosis provides an accurate and feasible intraoperative assessment of SLN status, achieving consistent results across multiple centres. This system may replace current histopathology-based techniques for intraoperative SLN analysis due to high concordance with histology and that it does not require input from a consultant pathologist. OSNA could allow more breast cancer patients in the UK access to one step axillary surgery.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1003.
Intra-operative sentinel lymph node metastasis detection by “one-step nucleic acid amplification (OSNA)”: results of the french multicentric study.
Authors: LeFrere Belda M , Bats A , Charon-Barra C , Crouet H , Houvenaeghel G , Clough K , Khaddage A , Leroux A , Lucas N , Nos C , Penault-Llorca F , Poulet B , Lecuru F 
Published: December 2010

Abstract
Abstract #1004
Background: Sentinel node (SLN) biopsy is widely used as a staging procedure in early breast cancer. usual procedures for intra-operative assessment have a low sensitivity and lead to reoperations for axillary dissection when the SLN is metastatic. The semi-automated OSNA test is based on a short sample preparation step and subsequent rapid amplification of CK19 mRNA. Results are available within 30 - 40 minutes. The OSNA method was developed to accurately detect metastases (≥ 0.2mm) in an intra-operative setting. The objective of this study was to evaluate diagnostic performance of OSNA in comparison to intensive histological examination.&#x2028; Methods: A total of 509 fresh SLN (234 patients) were cut into four slices. Two alternate slices were analysed by OSNA, the remaining ones were cut at 200µm intervals. On each level, Haematoxylin & Eosin and immunohistochemical staining (CK19 and AE1/AE3) were performed. In case of discordant results, the lysates of samples were subjected to QRT-PCR and Western Blot (Discordant Case Investigation, DCI) in order to detect whether the discordances were caused by tissue allocation bias (TAB): localisation of tumour deposits in only one slice due to the study design.&#x2028; Results: results were concordant for 202/234 patients (33 positive and 169 negative). 17/32 discordant cases were due to TAB. 2 cases were ininterpretable due to procedure errors. For remaining discordant cases, 2 were histology + / OSNA - and 11 were histology - / OSNA + (8 of them had CK 19 expression levels close to the cutoff). The sensitivity was 94.30% and specificity 93.90%. The overall concordance rate was 93.96%.&#x2028; Conclusion: OSNA is a rapid and accurate tool for intra-operative assessment of SLN and could reduce the reoperation rate for secondary axillary dissection when the SLN is metastatic.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1004.
Five year follow-up of patients with operable breast cancer whose sentinel nodes were completely sectioned at 0.25mm.
Authors: Dowlatshahi K , Alvarado R , Harrison M , Witt T , Gatta J , Bloom K 
Published: December 2010

Abstract
Abstract #1017
Background: 20-30% of patients with operable breast cancer and negative axillary lymph nodes develop recurrence within 10 years. With the advent of sentinel lymph node biopsy (SLNB) as a substitute to axillary lymph node dissection for staging of these patients, detailed examination of sentinel nodes for metastases has become feasible. Our group has previously reported on detection of 25% occult metastases in 200 patients with T1-T2 invasive breast cancer whose sentinel nodes were initially sectioned at 2-3 mm intervals and stained with H&E. The blocks were then sectioned at 0.25 mm intervals in the entirety and stained with immuno-histochemical technique (IHC). Some patients were given conventional chemo-hormonal therapy based upon tumor prognostic factors. We now present the disease recurrence in these patients at median follow-up of five years.&#x2028; Methods: Prospectively registered records of 209 consecutive patients with T1-T2 invasive breast cancer treated with lumpectomy and sentinel node biopsy at Rush University Medical Center by three surgeons between December 1997 and May 2002 were reviewed. Of the remaining 175, the nodes were sectioned at 0.25 mm throughout and stained with IHC. The remaining 123 cases had no metastases. Adjuvant chemo-hormonal therapy was given to 38 patients with unfavorable prognostic factors and none to 85.&#x2028; Results: The mean age of the patients and their tumor size were 54.6 years and 1.44 cm respectively. The mean length of follow up was 5.8 years. 34 of 209 patients had metastases in their sentinel nodes based on 2-3 mm sectioning and H&E staining. They were offered adjuvant chemo-hormonal therapy. 27 accepted and7 did not. Of the 209 patients, 175 had negative SLNB by routine examination. Of these, 52 (29.7%) were found to have occult metastases (isolated cells: 31, colonies&gt; 0.2 mm: 21) upon 0.25 mm sectioning and IHC staining. Details of the findings are summarized in the table. The incidence of disease recurrence was noted to be similar in the subsets of patients with and without occult metastases.&#x2028; Conclusion&#x2028; Complete sectioning of the sentinel nodes in 209 patients with T1 and T2 breast cancer resulted in detection of occult metastases in 52 patients ranging in size from single cells to colonies of cells measuring up to 1500 microns. However, the incidence of disease recurrence at 5 year appears unaffected by these metastases.&#x2028; &#x2028; m*: Small metastases: isolated cells&#x2028; M*: Large metastases: colonies of cells.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1017.
The use of ultrasound in pre-operative assessment of the axilla in breast cancer.
Authors: Hogan BV , Shenoy HG , Peter MB , Langlands FE , Dall BJ , Horgan KM 
Published: December 2010

Abstract
Abstract #1019
Introduction&#x2028; Sentinel lymph node biopsy is now standard practice in axillary staging in breast cancer. It is associated with less morbidity than an axillary node clearance. A drawback of sentinel node biopsy is the need for a second surgical procedure if the sentinel node shows metastases. Clinical examination of the axilla has been the standard pre-operative assessment but this has been shown to be unreliable. More recently ultrasound has been used to identify axillary metastases pre-operatively. The aim of our study is to assess the role of pre-operative ultrasound and fine needle aspirate cytology in refining the selection of patients for whom sentinel node biopsy is appropriate.&#x2028; Methods&#x2028; Three hundred patients with primary operable invasive breast cancer had axillary ultrasound preoperatively. If the ultrasound was normal the patient was offered a sentinel node procedure. If it identified equivocal nodes a fine needle cytology was performed. If the cytology was benign a sentinel node biopsy was performed. If the cytology was malignant then an axillary node clearance was performed. In cases where pathological nodes were identified on imaging, cytology was performed to confirm malignancy. An axillary node clearance was then performed.&#x2028; Results.&#x2028; Eighty three percent of our patients (n=249) had a normal axillary ultrasound pre-operatively. Of these 74.5% had a benign sentinel node biopsy. Sixty two percent of patients with equivocal nodes on pre-operative imaging had metastases on final histology (n=19). Of these 63% (n=12) were correctly identified pre-operatively with fine needle aspirate cytology of the equivocal node and had an axillary node clearance performed form the outset. Ultrasound identified pathological nodes in 7% of our patients (n=20). Malignancy was confirmed on cytology and an axillary node clearance was performed.&#x2028; Using ultrasound and fine needle aspirate cytology to assess the axilla pre-operatively sentinel node biopsy was performed in 265 patients (88%). Of these, 74.8% had a benign final histology. Thirty two patients had a pre-operative diagnosis of nodal metastases and had an axillary node clearance. All 32 had lymph node metastases on final histology. Factors that predicted for a malignant sentinel node were lymphovascular invasion (p&lt;0.001), tumour grade (p&lt;0.008) and size of tumour (p&lt;0.001).&#x2028; Conclusion&#x2028; Eighty eight percent of our patients had a sentinel lymph node biopsy to stage the axilla. Pre-operative ultrasound combined with cytology correctly determined the status of the node in 78% of cases. Our rate of second axillary operations was reduced by 32%. Importantly all patients diagnosed with node metastases pre-operatively and advised to have an axillary node clearance did have metastases on final histology.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1019.
Sentinel lymph node biopsy after neoadjuvant chemotherapy is accurate in breast cancer patients with a clinically negative axillary nodal status at presentation.
Authors: Gimbergues P , Abrial C , Le Bouedec G , Cachin F , Penault-Llorca F , Mouret-Reynier M , Kwiatkowski F , Maublant J , Tchirkov A , Dauplat J , Chollet P , Durando X 
Published: December 2010

Abstract
Abstract #1020
Background: In breast cancer, neoadjuvant chemotherapy (NAC) is widely used in order to enable a conservative surgery. In patients treated with NAC, the use of sentinel lymph node (SLN) biopsy, which is a good predictor of the axillary nodal status in previously untreated patients, is still discussed. The aim of our study was to determine clinicopathological factors that may influence the accuracy of SLN biopsy after NAC.&#x2028; Patients and methods : Between March 2001 and December 2006, 129 patients with infiltrating breast carcinoma were studied prospectively. Preoperatively, all of them underwent NAC. At surgery, SLN biopsy followed by axillary lymph node (ALN) dissection was performed. Lymphatic mapping was done using the isotope method.&#x2028; Results : The SLN identification rate was 93.8% (121/129). Fifty-six out of the 121 sucessfully mapped patients had positive ALN. Eight out of these 56 patients had tumor-free SLN (false-negative rate of 14.3%). The false-negative rate was correlated with larger tumor size (T1-T2 versus T3; p=0.045) and positive clinical nodal status (N0 versus N1-N2; p=0.003) before NAC. In particular, the false-negative rate was 0% (0/29) in N0 patients and 29.6% (8/27) in N1-N2 patients. Clinical and pathological responses to NAC did not influence the accuracy of SLN biopsy.&#x2028; Conclusion : Our results show that clinical nodal status is the main clinicopathological factor influencing the false-negative rate of SLN biopsy after NAC for breast cancer. SLN biopsy after NAC can predict the ALN status with a high accuracy in patients who are clinically lymph node negative at presentation.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1020.
Subareolar injection may not always identify the same sentinel lymph nodes as peritumoral injection in breast cancer.
Authors: Inokuchi M , Noguchi M , Zen Y 
Published: December 2010

Abstract
Abstract #1022
Background. Sentinel lymph node (SLN) biopsy is widely accepted as a standard surgical procedure for early breast cancer, but the optimal site for injection of mapping tracers is still controversial. We evaluated whether a combination of peritumoral injection and subareolar injection can improve the identification rate of SLN biopsy and decrease the false-negative rate.&#x2028; Methods. From August 2006 to April 2008, 155 patients with biopsy-proven operable breast cancer underwent SLN biopsy with peritumoral injection of radioisotope (Tc-99m-phytate) and subareolar injection of blue dye (patent blue dye).&#x2028; Results. The overall identification rate for blue and/or radioactive (hot) lymph nodes was 99.4% (154/155); the identification rate of blue-dyed lymph nodes was 98.1% (152/155) and of hot lymph nodes was 96.8% (150/155). A total number of the excised SLNs were 379 in these 154 patients, and the average number of SLNs in each patient was 2.4 (range, 1-9). The average number of SLNs was 2.0 (range, 1-8) for blue dye and 1.9 (range, 1-6) for radioactive (hot). Two hundred twenty-six nodes (59.6%) were blue and hot, while 79 were blue-only and 74 were hot-only. Consequently, no concordance between the hot node and the blue node was found in 14 of 154 patients (9.1%). Eight of these 14 patients had separate blue-only nodes and hot-only nodes (so-called sequential mismatch). Four patients had SLNs identified by blue dye only, whereas 2 patients had SLNs localized solely by radioisotope labeling. On the other hand, metastatic disease was identified in SLNs of 40 of 154 patients (26.0%). A number of positive SLNs were 55 in these 40 patients, where 34 nodes (61.8%) were blue and hot, 9 were blue-only and 12 were hot-only. Among these 40 patients, 30 patients (75.0%) had blue and hot positive SLN. Four patients had blue-only positive SLN and 4 patients had hot-only positive SLN. Two patients had separate blue-only positive SLN and hot-only positive SLN. The SLN was the only positive node in 24 of the 41 positive SLN mapping (60%). Consequently, the false-negative rates were 9.8% (4/41) for peritumoral injection and 9.8% (4/41) for subareolar injection. There were no significant differences between peritumoral and subareolar injection. However, both injection methods complemented each other, thereby decreasing the false-negative rate to 0%. It is important to note that metastatic disease was identified by peritumoral injection in 4 patients in which the SLN was hot-only. At a median follow-up of 10.5 months (range, 2-22 months), there were no axillary recurrences in any of the 155 patients.&#x2028; Conclusions. Subareolar injection may not always identify the same SLN as peritumoral injection. Subareolar injection of blue dye and peritumoral injection of radioisotope improves the identification rate of the SLN and decrease the false-negative rate of SLN biopsy.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1022.
Sentinel lymph node detection in breast cancer patients by real-time virtual sonography constructed with three-dimensional computed tomography-lymphography.
Authors: Yamamoto S , Maeda N , Tamesa M , Nagashima Y , Oka M 
Published: December 2010

Abstract
Abstract #1026
Background: Ultrasonography (US) is one tool for preoperative diagnosis of lymph node metastases in breast cancer. However, US cannot detect true sentinel lymph nodes (SLNs).&#x2028; Methods: We identified SLNs in 60 clinically node-negative breast cancer patients using a real-time virtual sonography (RVS) system to display in real time a virtual multi-planar reconstruction obtained from computed tomography (CT) volume data corresponding to the same cross-sectional image from US. CT volume data were obtained from our original three-dimensional CT lymphography (3DCT-LG), which accurately detects SLNs in breast cancer. SLN metastases were assessed by shape and visibility of the hilum. All patients underwent SLN biopsy and SLN metastases were examined pathologically.&#x2028; Results: In all 60 patients, we were able to detect the same SLNs visualized by 3DCT-LG. Suspicious SLN metastases were identified in 7 of the 60 patients, and 4 of 7 patients were pathologically positive. Positive predictive value was 57%. The remaining 53 patients displayed non-suspect SLNs in which absence of metastasis from the SLN was confirmed histologically. Overall accuracy was 95%.&#x2028; Conclusions: This is a first attempt at preoperatively identifying SLNs using US guided by the RVS system in breast cancer patients. Although evaluation of SLN metastases was unsatisfactory, this method may be useful for preoperative fine-needle aspiration cytology for diagnosis of SLN metastases.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1026.
The effect of raloxifene on vascular endothelial growth factor expression in breast carcinomas of postmenopausal women.
Authors: da Silva BB , dos Santos AR , Lopes-Costa PV , Pires CG , Facina G , Nazário AC 
Published: December 2010

Abstract
Abstract #1031
Background: To evaluate the effect of raloxifene on vascular endothelial growth factor (VEGF) expression in breast carcinomas of postmenopausal women. Materials and Methods: Sixteen postmenopausal patients with operable stage II, estrogen receptor-positive, infiltrating ductal breast carcinoma were treated with raloxifene at the dose of 60 mg/day for a period of 28 days prior to definitive surgery. Tumor size varied from 3 to 5 cm (mean 3.7 cm) and the mean age of patients was 61.8 years (range 49-72 years). Tumor samples were obtained by incisional biopsy at the time of diagnosis and again at the time of definitive surgical treatment. VEGF expression was obtained by immunohistochemistry (primary anti-VEGF monoclonal antibody, IgG, C-1, sc-7269, 200 mg/ml, Santa Cruz Biotechnology, Santa Cruz, USA). Evaluation of VEGF expression was assessed semiquantitatively based on the fraction of stained tumor cells and on the intensity of staining. McNemar's test of symmetry was used to evaluate agreement between the positive or negative classification of VEGF expression prior to and following raloxifene treatment (p&lt;0.05). Results: Fourteen of the 16 patients (88%) were classified as positive for VEGF expression prior to raloxifene treatment, while only 5 (31%) were classified as positive following treatment (p&lt;0.007) (see Figure 1 and Table 1).[figure1] &#x2028; &#x2028; Discussion: The results of the present study show that raloxifene reduced VEGF expression in breast cancer in postmenopausal women, thus suggesting that the drug may reduce neovascularization and the growth of estrogen receptor-positive breast tumors and reinforcing the argument for its possible use both in chemoprevention and in the treatment of breast cancer.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1031.