Automated and rapid detection of cancer in suspicious axillary lymph nodes in patients with breast cancer

Abstract Preoperative staging of suspicious axillary lymph nodes (ALNs) allows patients to be triaged to ALN dissection or to sentinel lymph node biopsy (SLNB). Ultrasound-guided fine needle aspiration (FNA) and cytology of ALN is moderately sensitive but its clinical utility relies heavily on the c...

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Autores principales:	Juanjuan Li, Bradley M. Downs, Leslie M. Cope, Mary Jo Fackler, Xiuyun Zhang, Chuan-gui Song, Christopher VandenBussche, Kejing Zhang, Yong Han, Yufei Liu, Suzana Tulac, Neesha Venkatesan, Timothy de Guzman, Chuang Chen, Edwin W. Lai, Jingping Yuan, Saraswati Sukumar
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/86a221899d2a40bf8a198d08bfddb605
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spelling	oai:doaj.org-article:86a221899d2a40bf8a198d08bfddb6052021-12-02T15:23:18ZAutomated and rapid detection of cancer in suspicious axillary lymph nodes in patients with breast cancer10.1038/s41523-021-00298-62374-4677https://doaj.org/article/86a221899d2a40bf8a198d08bfddb6052021-07-01T00:00:00Zhttps://doi.org/10.1038/s41523-021-00298-6https://doaj.org/toc/2374-4677Abstract Preoperative staging of suspicious axillary lymph nodes (ALNs) allows patients to be triaged to ALN dissection or to sentinel lymph node biopsy (SLNB). Ultrasound-guided fine needle aspiration (FNA) and cytology of ALN is moderately sensitive but its clinical utility relies heavily on the cytologist’s experience. We proposed that the 5-h automated GeneXpert system-based prototype breast cancer detection assay (BCDA) that quantitatively measures DNA methylation in ten tumor-specific gene markers could provide a facile, accurate test for detecting cancer in FNA of enlarged lymph nodes. We validated the assay in ALN-FNA samples from a prospective study of patients (N = 230) undergoing SLNB. In a blinded analysis of 218 evaluable LN-FNAs from 108 malignant and 110 benign LNs by histology, BCDA displayed a sensitivity of 90.7% and specificity of 99.1%, achieving an area under the ROC curve, AUC of 0.958 (95% CI: 0.928–0.989; P < 0.0001). Next, we conducted a study of archival FNAs of ipsilateral palpable LNs (malignant, N = 72, benign, N = 53 by cytology) collected in the outpatient setting prior to neoadjuvant chemotherapy (NAC). Using the ROC-threshold determined in the prospective study, compared to cytology, BCDA achieved a sensitivity of 94.4% and a specificity of 92.5% with a ROC-AUC = 0.977 (95% CI: 0.953–1.000; P < 0.0001). Our study shows that the automated assay detects cancer in suspicious lymph nodes with a high level of accuracy within 5 h. This cancer detection assay, scalable for analysis to scores of LN FNAs, could assist in determining eligibility of patients to different treatment regimens.Juanjuan LiBradley M. DownsLeslie M. CopeMary Jo FacklerXiuyun ZhangChuan-gui SongChristopher VandenBusscheKejing ZhangYong HanYufei LiuSuzana TulacNeesha VenkatesanTimothy de GuzmanChuang ChenEdwin W. LaiJingping YuanSaraswati SukumarNature PortfolioarticleNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENnpj Breast Cancer, Vol 7, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Juanjuan Li Bradley M. Downs Leslie M. Cope Mary Jo Fackler Xiuyun Zhang Chuan-gui Song Christopher VandenBussche Kejing Zhang Yong Han Yufei Liu Suzana Tulac Neesha Venkatesan Timothy de Guzman Chuang Chen Edwin W. Lai Jingping Yuan Saraswati Sukumar Automated and rapid detection of cancer in suspicious axillary lymph nodes in patients with breast cancer
description	Abstract Preoperative staging of suspicious axillary lymph nodes (ALNs) allows patients to be triaged to ALN dissection or to sentinel lymph node biopsy (SLNB). Ultrasound-guided fine needle aspiration (FNA) and cytology of ALN is moderately sensitive but its clinical utility relies heavily on the cytologist’s experience. We proposed that the 5-h automated GeneXpert system-based prototype breast cancer detection assay (BCDA) that quantitatively measures DNA methylation in ten tumor-specific gene markers could provide a facile, accurate test for detecting cancer in FNA of enlarged lymph nodes. We validated the assay in ALN-FNA samples from a prospective study of patients (N = 230) undergoing SLNB. In a blinded analysis of 218 evaluable LN-FNAs from 108 malignant and 110 benign LNs by histology, BCDA displayed a sensitivity of 90.7% and specificity of 99.1%, achieving an area under the ROC curve, AUC of 0.958 (95% CI: 0.928–0.989; P < 0.0001). Next, we conducted a study of archival FNAs of ipsilateral palpable LNs (malignant, N = 72, benign, N = 53 by cytology) collected in the outpatient setting prior to neoadjuvant chemotherapy (NAC). Using the ROC-threshold determined in the prospective study, compared to cytology, BCDA achieved a sensitivity of 94.4% and a specificity of 92.5% with a ROC-AUC = 0.977 (95% CI: 0.953–1.000; P < 0.0001). Our study shows that the automated assay detects cancer in suspicious lymph nodes with a high level of accuracy within 5 h. This cancer detection assay, scalable for analysis to scores of LN FNAs, could assist in determining eligibility of patients to different treatment regimens.
format	article
author	Juanjuan Li Bradley M. Downs Leslie M. Cope Mary Jo Fackler Xiuyun Zhang Chuan-gui Song Christopher VandenBussche Kejing Zhang Yong Han Yufei Liu Suzana Tulac Neesha Venkatesan Timothy de Guzman Chuang Chen Edwin W. Lai Jingping Yuan Saraswati Sukumar
author_facet	Juanjuan Li Bradley M. Downs Leslie M. Cope Mary Jo Fackler Xiuyun Zhang Chuan-gui Song Christopher VandenBussche Kejing Zhang Yong Han Yufei Liu Suzana Tulac Neesha Venkatesan Timothy de Guzman Chuang Chen Edwin W. Lai Jingping Yuan Saraswati Sukumar
author_sort	Juanjuan Li
title	Automated and rapid detection of cancer in suspicious axillary lymph nodes in patients with breast cancer
title_short	Automated and rapid detection of cancer in suspicious axillary lymph nodes in patients with breast cancer
title_full	Automated and rapid detection of cancer in suspicious axillary lymph nodes in patients with breast cancer
title_fullStr	Automated and rapid detection of cancer in suspicious axillary lymph nodes in patients with breast cancer
title_full_unstemmed	Automated and rapid detection of cancer in suspicious axillary lymph nodes in patients with breast cancer
title_sort	automated and rapid detection of cancer in suspicious axillary lymph nodes in patients with breast cancer
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/86a221899d2a40bf8a198d08bfddb605
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Automated and rapid detection of cancer in suspicious axillary lymph nodes in patients with breast cancer

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