One-step nucleic acid amplification for intraoperative analysis of sentinel lymph node in papillary thyroid carcinoma

• Published in: European journal of endocrinology Vol. 180; no. 1; pp. 21 - 29
• Main Authors: Iglesias Felip, Carmela, Zafon Llopis, Carles, Temprana-Salvador, Jordi, García-Burillo, Amparo, Serres Créixams, Xavier, Caubet Busquet, Enric, Roca Bielsa, Isabel, Mesa Manteca, Jordi, Castell Conesa, Joan, Fort López-Barajas, José Manuel, Pujol-Borrell, Ricardo, Ramon y Cajal Agüeras, Santiago, González López, Oscar
• Format: Journal Article
• Language: English
• Published: England Bioscientifica Ltd 01.01.2019; Oxford University Press
• Subjects: Acids; Adenocarcinoma, Papillary - genetics; Adenocarcinoma, Papillary - pathology; Adult; Biopsy; Cellular biology; Clinical Study; Cytokeratin; Cytology; Female; Humans; Lymph Node Excision; Lymph nodes; Lymphatic Metastasis - genetics; Lymphatic Metastasis - pathology; Male; Metastases; Middle Aged; mRNA; Nucleic Acid Amplification Techniques - methods; Nucleic acids; Papillary thyroid carcinoma; Patients; Risk groups; Sentinel Lymph Node - pathology; Sentinel Lymph Node Biopsy; Surgery; Thyroid; Thyroid cancer; Thyroid Neoplasms - genetics; Thyroid Neoplasms - pathology; Tumors
• ISSN: 0804-4643; 1479-683X
• DOI: 10.1530/EJE-18-0624

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.