Molecular Diagnosis for Nodal Metastasis in Endoscopically Managed Cervical Cancer: The Accuracy of the APTIMA Test to Detect High-risk Human Papillomavirus Messenger RNA in Sentinel Lymph Nodes.
STUDY OBJECTIVE
To evaluate the feasibility and accuracy of a commercially available test to detect E6/E7 mRNA of 14 subtypes of high-risk HPVs (APTIMA; Hologic, Bedford, MA) in the sentinel lymph nodes of CC patients laparoscopically operated.


DESIGN
Prospective pilot study.


SETTING
The study was conducted in the Department of Advanced Operative and Oncologic Gynecology, Asklepios Hospital, Hamburg, Germany.


PATIENTS
54 women with HPV-positive CC submitted to laparoscopic sentinel node biopsy alone or sentinel node biopsy followed by systematic pelvic and/or para-aortic endoscopic lymphadenectomy.


INTERVENTIONS
All removed sentinel lymph nodes (SLNs) underwent sample collection by cytobrush for the APTIMA assay before frozen section.


MEASUREMENTS
Results obtained with the HPV mRNA test were compared with the definitive histopathological analysis of the SLNs and additional lymph nodes removed.


RESULTS
A total of 125 SLNs (119 pelvic and 6 paraaortic) were excised with a mean number of 2.3 SLNs per patient. Final histopathologic analysis confirmed nodal metastases in 10 SLNs from 10 different patients (18%). All the histologically confirmed metastatic lymph nodes were also HPV E6/E7 mRNA positive, resulting in a sensitivity of 100%. Four histologically free sentinel nodes were positive for HPV E6/E7 mRNA, resulting in a specificity of 96.4%.


CONCLUSION
The HPV E6/E7 mRNA assay in the SLNs of patients with CC is feasible and highly accurate. The detection of HPV mRNA in 4 women with negative SLNs might denote a shift from microscopic identification of metastasis to the molecular level. The prognostic value of this findings awaits further verification.
['Köhler|Christhardt|C|', 'Le|Xin|X|', 'Dogan|Nasuh Utku|NU|', 'Pfiffer|Tatiana|T|', 'Schneider|Achim|A|', 'Marnitz|Simone|S|', 'Bertolini|Julia|J|', 'Favero|Giovanni|G|']
D000230:Adenocarcinoma D000328:Adult D000368:Aged D001011:Aorta D002294:Carcinoma, Squamous Cell D005260:Female D005858:Germany D061809:Human Papillomavirus DNA Tests D052163:Human papillomavirus 6 D006801:Humans D010535:Laparoscopy D008197:Lymph Node Excision D008207:Lymphatic Metastasis D008875:Middle Aged D025202:Molecular Diagnostic Techniques D009367:Neoplasm Staging D027383:Papillomaviridae D030361:Papillomavirus Infections D010388:Pelvis D010865:Pilot Projects D011379:Prognosis D011446:Prospective Studies D012333:RNA, Messenger D000071036:Sentinel Lymph Node D021701:Sentinel Lymph Node Biopsy D002583:Uterine Cervical Neoplasms D055815:Young Adult
Nodal metastasis Cervical cancer Human papillomavirus messenger RNA Endoscopic sentinel node biopsy Molecular diagnostic