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. 2023 Nov;202(2):245-255.
doi: 10.1007/s10549-023-07065-0. Epub 2023 Jul 27.

Impact of analysis of the sentinel lymph node by one-step nucleic acid amplification (OSNA) compared to conventional histopathology on axillary and systemic treatment: data from the Dutch nationwide cohort of breast cancer patients

Elisabeth R M van Haaren  1 , Ingrid G M Poodt  2 , Merel A Spiekerman van Weezelenburg  2 , James van Bastelaar  2 , Alfred Janssen  2 , Bart de Vries  3 , Marc B I Lobbes  4   5 , Lee H Bouwman  2   6 , Yvonne L J Vissers  2
Affiliations

Impact of analysis of the sentinel lymph node by one-step nucleic acid amplification (OSNA) compared to conventional histopathology on axillary and systemic treatment: data from the Dutch nationwide cohort of breast cancer patients

Elisabeth R M van Haaren et al. Breast Cancer Res Treat. 2023 Nov.

Abstract

Purpose: The outcome of the sentinel lymph node in breast cancer patients affects adjuvant treatment. Compared to conventional histopathology, analysis by one-step nucleic acid amplification (OSNA) harvests more micrometastasis, potentially inducing overtreatment. In this study we investigated the impact of OSNA analysis on adjuvant treatment, compared to histopathological analysis.

Methods: Data from T1-3 breast cancer patients with sentinel nodes analysed between January 2016 and December 2019 by OSNA (OSNA group, n = 1086) from Zuyderland Medical Centre, the Netherlands, were compared to concurrent data from the Netherlands Cancer Registry (NKR) where sentinel nodes were examined by histology (histology group, n = 35,143). Primary outcomes were micro- or macrometastasis, axillary treatments (axillary lymph node dissection (ALND) or axillary radiotherapy (ART)), chemotherapy, and endocrine therapy. Statistics with Pearson Chi-square.

Results: In the OSNA group more micrometastasis (14.9%) were detected compared to the histology group (7.9%, p < 0.001). No difference in axillary treatment between groups was detected (14.3 vs. 14.4%). In case of mastectomy and macrometastasis, ALND was preferred over ART in the OSNA group (14.9%) compared to the histology group (4.4%, p < 0.001). In cases of micrometastasis, no difference was seen. There was no difference in administration of adjuvant chemotherapy between groups. Endocrine treatment was administrated less often in the OSNA group compared to the histology group (45.8% vs. 50.8%, p < 0.002).

Conclusion: More micrometastasis were detected by OSNA compared to histopathology, but no subsequent increase in adjuvant axillary and systematic treatment was noticed. When performing mastectomy and OSNA, there was a preference for ALND compared to ART.

Keywords: Adjuvant treatment; Breast cancer; One-step nucleic acid amplification; Sentinel lymph node biopsy.

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Conflict of interest statement

All authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Flowchart patient selection and data collection
Fig. 2
Fig. 2
Axillary treatment in mastectomy or breast-conserving treatment
Fig. 3
Fig. 3
Percentage axillary treatment in patients with micrometastasis
See this image and copyright information in PMC

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