Accuracy of One-Step Nucleic Acid Amplification in Detecting Lymph Node Metastases in Endometrial Cancer
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REVIEW
Accuracy of One-Step Nucleic Acid Amplification in Detecting Lymph Node Metastases in Endometrial Cancer Antonio Raffone 1 & Antonio Travaglino 2 & Angela Santoro 3 & Italia Esposito 1 & Giuseppe Angelico 3 & Saveria Spadola 3 & Gian Franco Zannoni 3 Received: 25 June 2019 / Accepted: 14 August 2019 # Arányi Lajos Foundation 2019
Abstract One-step nucleic acid amplification (OSNA) is used to intraoperatively detect sentinel lymph node metastases in breast cancer. OSNA has also been proposed in endometrial cancer, but evidence in this regard is unclear to define the diagnostic accuracy of OSNA in detecting lymph node metastases in endometrial cancer. A systematic review and meta-analysis was performed by searching 8 electronic databases from their inception to March 2019 for studies testing the diagnostic accuracy of OSNA in detecting sentinel lymph node metastasis in endometrial cancer. Pathologic ultrastaging was the reference standard. Sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR-), diagnostic odds ratio (DOR) and area under the curve (AUC) on SROC curve were calculated. Four studies with 237 patients and 691 lymph nodes were included. OSNA showed sensitivity = 0.88, specificity = 0.93, LR + =17.95, LR- = 0.15, DOR = 191.23 and high diagnostic accuracy (AUC = 0.959). OSNA appears as a highly accurate tool for intraoperative assessment of sentinel lymph node in endometrial cancer. Keywords OSNA . Sentinel lymph node . Endometrial cancer . Intraoperative . Ultrastaging . Tailored medicine
Intoduction Endometrial carcinoma (EC) is the most common gynecologic cancer in developed countries [1–4]. EC is often detected in an early phase, when the tumor is limited to the uterus and lymph nodes are not involved, with a consequent excellent prognosis [5–7]. However, when EC metastasizes to lymph nodes, the 5years survival rate dramatically decreases from 80 to 90% (FIGO stage I-II) to 51–58% (FIGO stage IIIC) [8]. Therefore, lymph nodes staging is a crucial step in * Antonio Raffone [email protected] 1
Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy
2
Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
3
Pathology Unit, Department of Woman and Child Health, Agostino Gemelli University Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
determining the management of EC, and lymphadenectomy is recommended as standard intervention, except for stage FIGO Ia, low grade EC [9–11]. Nonetheless, lymphadenectomy requires surgical expertise, and it is associated with increased risk of perioperative and postoperative morbidity [12]. For this reason, the possibility of using sentinel lymph node (SLN) examination in EC has received great interest [13–17]. In fact, SLN examination allows the assessment of lymph node staging without the implications related to a w
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