Sentinel node biopsies in XXXX @entity1 : a protocol for accurate, efficient, and cost-effective analysis by preselection for immunohistochemistry on the basis of Tyr-PCR.

@entity1 @entity5 @entity1711 @entity1710 @entity11442 @entity320
BACKGROUND: Immunohistochemistry (IHC) of serial sectioning is considered the gold standard for detection of @entity320 activity in sentinel node (SN) biopsies. However, this is cost and labor intensive. In contrast, @entity11442 reverse transcription-polymerase chain reaction (RT-PCR) is simple and quick, but it is hampered by its extreme sensitivity. This study was performed to test whether a strategy that combines the two methods, using @entity11442 RT-PCR to preselect nodes for IHC, could be accurate and cost effective. METHODS: In 36 @entity1 , SNs were identified by scintigraphy and patent blue uptake. Of each SN, one cross section was analyzed first by @entity1710 and @entity1711 staining. Next, all nodes were examined by serial sectioning and IHC of one-half and @entity11442 RT-PCR of the other. Before comparison, all results were documented in a blinded manner. Material costs and workload estimates were noted per SN. RESULTS: Fifty-five SNs were retrieved from the 36 @entity1 . @entity1710 and @entity1711 staining of the first cross section revealed @entity5 positivity in 3 @entity1 (6 SN). @entity11442 RT-PCR was positive in 11 of the remaining 33 @entity1 (19 of 49 SN). Of these same 11 @entity1 , only 5 were shown to have @entity5 -positive SNs by using IHC on serial sections (7 SN). All these nodes had been positive for @entity11442 on PCR. For IHC, an average of 40 sections were prepared and examined per SN at a cost of  200(U.S.)/SN. In contrast, routine @entity11442 RT-PCR costs  37(U.S.)/SN, and takes 5% of the time necessary for IHC. A strategy including @entity1710 and @entity1711 staining on the first cross section, followed by @entity11442 RT-PCR on half of each negative (half) node, could preselect nodes to be taken through serial sectioning. In these series, such a strategy would have prevented serial sectioning and IHC of 30 SN from 22 @entity1 . Apart from a considerable gain in efficiency, this would have reduced material costs by a minimum of  6000 (U.S.). This discrepancy would be even higher if work intensity of analysts and pathologists were considered. CONCLUSIONS: In routine analysis of SN biopsies in @entity320 @entity1 , @entity11442 RT-PCR can be used effectively to preselect nodes for further IHC of serial sections. This method seems both time and cost effective.
