One-step nucleic acid amplification: the possible value in assessing sentinel lymph node metastasis during mastectomy

Abstract

Breast cancer is the most common cancer in women, worldwide, and 1,400 deaths per day are attributed to it. The success of national screening programs has seen breast cancers being diagnosed at an earlier stage. With conservative surgery to the breast demonstrating equivalent long-term outcomes, the last 10 years have seen a growing interest in the safety of less invasive management for the axilla in breast cancer patients. One-step nucleic acid amplification (OSNA) is a validated, reliable, and efficient tool in identifying micro- and macro-metastases intraoperatively. It is the most widely used intraoperative analysis tool within the United Kingdom, and is employed by over 320 units across Europe and Asia. Recent evidence from the AMAROS, IBCSG 23-01, and ACOSOG Z0011 trials has changed surgical practice in managing the axilla of patients with breast cancer. We propose a clinical algorithm demonstrating the role of OSNA as an intraoperative analysis tool in today's management of breast cancer as well as prospects for the future use of OSNA.

Keywords: breast cancer; intraoperative assessment; mastectomy; one-stop nucleic acid amplification; sentinel lymph node.

Figure 1

Best evidence management of the axilla in patients with newly diagnosed breast cancer. Abbreviations: LN, lymph node; mets, metastases; WLE, wide local excision; Mx, mastectomy; NAC, neoadjuvant chemotherapy; LVI, lymphovascular invasion; Pre-Rx, pre-therapy; MDT, multidisciplinary team meeting; ALND, axillary lymph node dissection; OSNA, one-step nucleic acid amplification; SLN, sentinel lymph node; dx, disease.