Abstract P3-03-11: Intraoperative assessment of the sentinel node in breast cancer by one step nucleic acid assay: Experience of over 1100 patients

Introduction

The intraoperative assessment of the sentinel node in women with breast cancer enables an immediate axillary node clearance to be done as part of the same operative procedure if the sentinel node is positive. This has significant benefits for the Patient, the Surgeon and the Health Care Provider. There are a variety of methods for the intra-operative assessment of the sentinel node which include: Touch Imprint Cytology, Frozen Section Analysis and Polymerase Chain Reaction (PCR) based molecular assays. OSNA is an automated molecular assay using a Polymerase Chain Reaction (PCR), which detects the presence of cytokeratin 19 in the sentinel node. We report our experience of OSNA for the intraoperative assessment of the sentinel node in our institution with 1148 patients.

Methods

All patients with operable breast cancer who were found to be node negative on clinical and radiological assessment of the axilla, and who had their axilla staged by a sentinel node biopsy at the Breast Unit at Warwick Hospital, UK over a 7 year period were included in this study. Data was collected from a prospective database maintained at the Breast Unit. The axillary node positivity rate and the number of patients with macrometastatic and micrometastatic disease as detected by OSNA was collected and compared with a group of 411 patients who had the intraoperative assessment by Touch Imprint Cytology and final histology by conventional Haematoxylin & Eosin (H&E) assessment, prior to the introduction of OSNA. The Chi-square test were used for statistical significance.

Results

1148 patients had their sentinel node assessed intraoperatively using OSNA in this 7 year study period. The sentinel node was positive in 376 patients (32.8%). Of those who had a positive node, 183 (15.9%) had macro-metastatic disease and 193 (16.8%) had micro-metastatic disease. When compared to 411 patients in the pre-OSNA period, that were assessed by Touch Imprint Cytology and H&E sections, the node positivity rate increased from 23.8% to 32.8% (p<0.05) with the introduction of OSNA. Whilst there was no significant increase in the rate of macrometastatic disease – 20.4% versus 15.9 % ( p0.038), there was a significant increase in the patients who had micrometastases detected on OSNA - 3.4% versus 16.8 % ( p<0.05) as shown in the table.

Conclusion

Our results demonstrate that OSNA is a more sensitive test for picking up metastatic disease, especially micrometastatic disease, in the sentinel node. Whilst this did cause some anxiety initially, the results of recent trials like ACSOG Z-11 and IBCSG 23-01 have shown that small volume disease or micrometastases in the sentinel node do not require an axillary node clearance. Intraoperative assessment of the sentinel node with OSNA significantly upstages the axillary nodal status, especially with regard to micrometastatic disease, but the ability to proceed to an axillary node clearance at the same operation as the sentinel node biopsy, still has significant advantages for the Patient, Surgeon and Health Care Providers.

Citation Format: Clarke D, Sinha A, Ion L, Weston S, Jones L, Kham M, Harries S. Intraoperative assessment of the sentinel node in breast cancer by one step nucleic acid assay: Experience of over 1100 patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-11.

Submicrometer Hollow Bioglass Cones Deposited by Radio Frequency Magnetron Sputtering: Formation Mechanism, Properties, and Prospective Biomedical Applications

This work reports on the unprecedented magnetron sputtering deposition of submicrometric hollow cones of bioactive glass at low temperature in the absence of any template or catalyst. The influence of sputtering conditions on the formation and development of bioglass cones was studied. It was shown that larger populations of well-developed cones could be achieved by increasing the argon sputtering pressure. A mechanism describing the growth of bioglass hollow cones is presented, offering the links for process control and reproducibility of the cone features. The composition, structure, and morphology of the as-synthesized hollow cones were investigated by energy dispersive spectroscopy (EDS), Fourier transform infrared spectroscopy (FTIR), grazing incidence geometry X-ray diffraction (GIXRD), scanning electron microscopy (SEM), and transmission electron microscopy (TEM)-selected area electron diffraction (SAED). The in vitro biological performance, assessed by degradation tests (ISO 10993-14) and cytocompatibility assays (ISO 10993-5) in endothelial cell cultures, was excellent. This allied with resorbability and the unique morphological features make the submicrometer hollow cones interesting candidate material devices for focal transitory permeabilization of the blood-brain barrier in the treatment of carcinoma and neurodegenerative disorders.

Band alignment and charge transfer in rutile-TiO2/CH3NH3PbI3−xClx interfaces

Rutile-TiO₂/hybrid halide perovskite CH₃NH₃PbI_3−xCl_x interfaces are investigated by ab initio density functional theory calculations.

Salvage surgery for residual primary and locally recurrent anal squamous cell carcinoma after chemoradiotherapy in HIV-positive individuals

BACKGROUND

The treatment of anal cancer in human immunodeficiency virus (HIV) patients-as in the general population-is primarily with chemoradiotherapy (CRT), and abdominoperineal resection of residual or recurrent primary disease. The aim of this study was to evaluate the extent of residual primary disease and local recurrence as well as the outcome of salvage surgery after CRT for anal carcinoma in HIV-positive individuals.

METHODS

We retrospectively studied HIV-positive anal carcinoma patients treated between February 1989 and November 2012 in a specialist London unit. Extent of residual primary disease, local recurrence after CRT, postoperative complications, and survival after salvage surgery were evaluated.

RESULTS

Complete response was experienced in 44 of 53 (83%) of HIV patients treated with CRT for anal carcinoma. One patient (2.3%) developed local recurrence. Nine patients (eight residual primary disease after CRT and one local recurrence) underwent salvage surgery after CRT. There were no perioperative deaths, and perioperative CD4 counts were sustained. Complications occurred in five patients (55%). Median interval to complete perineal healing was 4 months (range 2-11 months), and median hospital stay was 29 days. Survival (median 16 months) was 25% at 2 years from salvage surgery.

CONCLUSIONS

Results in HIV-positive patients receiving highly active antiretroviral therapy (HAART) suggest that loss of HIV sensitivity to HAART can be avoided, but that there is increased postoperative morbidity that may be related to HIV disease. Survival was comparable to that for salvage therapy after optimal CRT in non-HIV anal carcinoma patients.

Magnetic behavior and clustering effects in Mn-doped boron nitride sheets

Ab initio calculations are performed in the framework of density functional theory on Mn-doped boron nitride sheets, which are candidates for two-dimensional diluted magnetic semiconductors (DMSs). Each type of substitution reveals a qualitatively different magnetic behavior encompassing ferromagnetic, anti-ferromagnetic and spin glass ordering. The ability of formation of these defects is also discussed. We analyze the dependence of the exchange couplings on the distance between impurities and the typical range and distribution are extracted. Multiple-impurity configurations are considered and the results are mapped on an Ising-type Hamiltonian with higher order exchange interactions, revealing deviations from the standard two-spin models. The percolation of interacting magnetic moments is discussed and the critical concentration is determined for the underlying transition from a ferromagnetic to a super-paramagnetic state. We conclude our study by providing the optimal conditions for doping in order to obtain a ferromagnetic DMS.

Organic photovoltaic cells based on ZnO thin film electrodes

Due to its wide band-gap (ca. 3.4 eV), ZnO is a possible candidate material to be used as transparent electrode for a new class of photovoltaic (PV) cells. Also, an increased interest for the photovoltaic properties of several organic monomers and polymers (merocyanines, phthalocyanines and porphyrins) was noticed, because of their high optical absorption in the visible region of the spectrum allowing them to be used as potential inexpensive materials for solar cells. Preparation and properties of CuPc (copper phthalocyanine) based photovoltaic cells using ZnO thin films as transparent conductor electrodes are presented in this paper. ZnO layers are grown by pulsed laser deposition, while the organic layers are obtained by thermal evaporation. Structural characterization is performed by electron microscopy. Optical and transport properties of the mutilayered structures are obtained by electrical and spectro-photometric measurements. The influence of the ZnO-polymer interface on the external quantum efficiency (EQE) of the photovoltaic cell is clearly evidenced by our measurements.

Optical phonon spectrum and the Fröhlich Hamiltonian in würtzite-type nanotubes

Dispersion laws of the full optical phonon spectrum of a nanotube made of würtzite-type materials as well as the corresponding Fröhlich electron-phonon interaction terms are derived and studied within the framework of the dielectric continuum model for a uniaxial crystal. The coupling coefficients describing electron-phonon interaction are obtained in an analytical closed form, depending on the dispersion law of the involved phonon branch. We present and discuss results of numerical calculations of optical phonon spectrum and Fröhlich coupling coefficients for some chosen würtzite AlN nanotubes. Observed features, induced by the anisotropy of würtzite-type materials, are discussed.

Leech-borne Serratia marcescens infection following complex hand injury

Leeches are commonly used in the postoperative course of plastic surgical operations where there is venous congestion in a pedicled or free flap. They provide a temporary relief to venous engorgement whilst venous drainage is re-established. It is known that leeches can carry Aeromonas hydrophila infection, and a second or third generation cephalosporin antibiotic has traditionally been given as prophylaxis against infection. We report a new observation that leeches can carry Serratia marcescens and give rise to clinically significant infection. The implication for prophylaxis and treatment of leech-associated cellulitis is discussed.

Are antibiotics necessary in the surgical management of upper limb lacerations?

Previous research has shown that antibiotic usage in patients with superficial sharp lacerations has no influence over infection rate. This study is a prospective controlled trial, using systematic allocation, of 250 patients of which 113 received co-amoxiclav (Augmentin) and 137 did not. Special emphasis was placed on wound debridement and irrigation. All sharp soft tissue lacerations including those with nerve, tendon and muscle damage were entered into the trial. The results show a low overall infection rate of 4%. The infection rate in the group treated with antibiotics was 5% and 3.2% in the group who received no antibiotics. Lacerations operated on up to 48 h from the injury were included and there was no correlation between the length of time waited and the infection rate. We conclude that antibiotics are an unnecessary adjunct in the treatment of sharp lacerations of the hand and upper limb, provided meticulous surgical debridement is performed.

Correlations between the activities of semen acid phosphatase and Ca(2+)-dependent ATPase and age in different breeds of cocks

1. The present work aims to find a biochemical criterion for evaluating the evolution of sperm according to age through the study of the ATPase activity from the spermatozoa and the acid phosphatase from the seminal plasma of cocks from three different breeds. 2. The optimal parameters of action of the cock semen acid phosphatase and the Ca(2+)-dependent ATPase from the spermatozoa were studied. 3. The substrate specificity of the semen acid phosphatase and its inhibition by tartrate, fluoride, metavanadate, molybdate and Hg2+ were also studied. 4. The two enzymes were determined from the Sussex, Golden Cornish and Plymouth Rock breeds at different ages. 5. The data lead to the conclusion that some properties of bird spermatozoa are less influenced by breed while the acid phosphatase activity, secreted in the ductus deferens is a breed characteristic.