Molecular staging of lymph node-negative colon carcinomas by one-step nucleic acid amplification (OSNA) results in upstaging of a quarter of patients in a prospective, European, multicentre study
Molecular staging of lymph node-negative colon carcinomas by one-step nucleic acid amplification (OSNA) results in upstaging of a quarter of patients in a prospective, European, multicentre study
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DOI：
10.1038/bjc.2014.170
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发表时间：
2014-05-13
影响因子：
8.8
通讯作者：
Zuber, M.
中科院分区：
文献类型：
--
作者：
Croner, R. S.;Geppert, C-I;Zuber, M.
背景：当前结肠癌的组织病理学分期程序取决于淋巴结的中线划分，仅用苏木精和伊红（H＆E）染色的一部分进行染色。通过这种方法，该横断线之外的肿瘤沉积可能会被遗漏，并可能导致 UICC II 期病例的高风险组被低估，这种情况在大约 20% 的病例中复发。一步核酸扩增 (OSNA) 是一种新的半自动化诊断系统，可检测淋巴结转移中的细胞角蛋白 (CK) 19 mRNA，并能够对整个淋巴结进行研究。本研究的目的是评估组织病理学 pN0 患者是否可以通过 OSNA 升级至 UICC III 期。方法：对标准组织病理学（单 (H&E) 切片）后被分类为淋巴结阴性的患者的淋巴结进行 OSNA。结果显示 CK19 mRNA 拷贝数 > 250，这确保主要检测到大转移灶，而不是仅检测孤立的肿瘤细胞 (ITC) 或微转移灶，根据之前的阈值调查，被视为淋巴结转移阳性。 结果：总共，来自 103 例结肠癌的 1594 个 pN0 淋巴结（每位患者的淋巴结中位数：14 个，范围： 1-46）用 OSNA 进行分析。在 103 名 pN0 患者中，26 名患者有 OSNA 阳性淋巴结，导致分期率为 25.2%。其中 6/37 (16.2%) 为 UICC I 期患者，20/66 (30.3%) 为 UICC II 期患者。总体而言，38 个淋巴结为 OSNA 阳性：19 名患者有 1 个，3 名患者有 2 个，3 名患者有 3 个，1 名患者有 4 个 OSNA 阳性淋巴结。结论：OSNA 导致超过 25% 的最初组织病理学淋巴结阴性患者的分期上调。 OSNA 是一种标准化、独立于观察者的技术，可以分析整个淋巴结。因此，可以避免由于缺少对某些淋巴结组织的调查而导致的采样偏差，这可能导致更准确的分期。
Background: Current histopathological staging procedures in colon carcinomas depend on midline division of the lymph nodes with one section of haematoxylin & eosin (H&E) staining only. By this method, tumour deposits outside this transection line may be missed and could lead to understaging of a high-risk group of stage UICC II cases, which recurs in similar to 20% of cases. A new diagnostic semiautomated system, one-step nucleic acid amplification (OSNA), detects cytokeratin (CK) 19 mRNA in lymph node metastases and enables the investigation of the whole lymph node. The objective of this study was to assess whether histopathological pN0 patients can be upstaged to stage UICC III by OSNA.Methods: Lymph nodes from patients who were classified as lymph node negative after standard histopathology (single (H&E) slice) were subjected to OSNA. A result revealing a CK19 mRNA copy number > 250, which makes sure to detect mainly macrometastases and not isolated tumour cells (ITC) or micrometastases only, was regarded as positive for lymph node metastases based on previous threshold investigations.Results: In total, 1594 pN0 lymph nodes from 103 colon carcinomas (median number of lymph nodes per patient: 14, range: 1-46) were analysed with OSNA. Out of 103 pN0 patients, 26 had OSNA-positive lymph nodes, resulting in an upstaging rate of 25.2%. Among these were 6/37 (16.2%) stage UICC I and 20/66 (30.3%) stage UICC II patients. Overall, 38 lymph nodes were OSNA positive: 19 patients had one, 3 had two, 3 had three, and 1 patient had four OSNA-positive lymph nodes.Conclusions: OSNA resulted in an upstaging of over 25% of initially histopathologically lymph node-negative patients. OSNA is a standardised, observer-independent technique, allowing the analysis of the whole lymph node. Therefore, sampling bias due to missing investigation of certain lymph node tissue can be avoided, which may lead to a more accurate staging.