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Clinical Relevance of Reverse Transcriptase-Polymerase Chain Reaction for the Detection of Axillary Lymph Node Metastases in Breast Cancer

From the Departments of Surgery (MWD, GNP, AML, DME) and Pathology (MS, AV, HS, AFG), University of Texas Southwestern Medical Center, Dallas, Texas.

Correspondence: Address correspondence and reprint requests to: David M. Euhus, MD, Division of Surgical Oncology, E6.222, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9155; Fax: 214-648-7965; E-mail: david.euhus{at}utsouthwestern.edu

Background: The mammary sentinel lymph node procedure can increase the detection of axillary metastases by 45% compared with standard axillary dissection. Some investigators have reported that reverse transcriptase-polymerase chain reaction (RT-PCR) increases metastasis detection even more, but it is uncertain whether a positive RT-PCR test in the face of a negative histological evaluation is clinically meaningful.

Methods: RT-PCR for epithelial glycoprotein 2 and cytokeratin 19 was performed on sentinel and pooled nonsentinel axillary lymph nodes from 108 women with clinical stage I or II breast cancer who were followed up for a median of 40 months.

Results: Axillary metastases were detected on standard tissue sections in 26% and by RT-PCR in 30%. Results for the two tests were concordant for 80% of the cases. RT-PCR upstaged 16%. Tumors from women whose lymph nodes were positive only by RT-PCR were phenotypically similar to those from women with no metastases detected by any method. Moreover, 4-year actuarial distant disease-free survival was 100% for women with metastases detected by RT-PCR only, as compared with 74% for those with metastases detected by routine histology (P = .03) and 93% for those with no metastases detected by either method (P = .04).

Conclusions: Analysis of sentinel lymph nodes by RT-PCR for epithelial glycoprotein 2 and cytokeratin 19 is unlikely to provide clinically useful information.

Key Words: Breast cancer • Sentinel nodes • RT-PCR • Cytokeratin-19 • EGP-2 • Survival

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