Surender Kumar, Shailendra Kumar, Raja Roy, Ankita Singh Rathore, Madhu Mati Goel, Gaurav Agarwal and Sandeep Kumar
Introduction: The extent of axillary lymph node involvement is one of the most important prognostic markers in patients of breast cancer. However, axillary dissection is associated with significant morbidity. The intra-operative sentinel node biopsy (SNB) provides a basis for omitting the routine axillary clearance however; use of in-house frozen section histopathology is required in order to substitute later. We report the use of in vitro high resolution magic angle proton magnetic resonance spectroscopy (HRMAS) for assessing the axillary nodal status with increased sensitivity.
Methods: Freshly removed axillary lymph nodes (n=17) obtained during sentinel node biopsy from 17 different patients were bisected. One segment of the bisected node was snap frozen and transported to HRMAS laboratory and was blindly subjected to 400 MHz high resolution magic angle proton magnetic resonance spectroscopy. The other portion was sent for frozen section biopsy. The tissues specimens used for HRMAS analysis and remaining portion of bisected node were then formalin fixed, paraffin embedded and sent for histo-pathological examination in separate vials. The metabolic profiles of these nodes were correlated with the routine histo-pathogical findings.
Results: On histo-pathological examination, 7 nodes were found to be positive for metastasis were as 10 nodes were negative. The spectra of nodes (n=7) found to be positive for malignant cells were exclusively dominated by signals from choline, choline containing compounds and lactate in the spectral region of 3.2 ppm and 4.12 ppm respectively. Overall the sensitivity and specificity of HRMAS in the present study was 100%.
Conclusion: Metastatic and non-involved lymph nodes in breast cancer can be accurately distinguished based on its metabolic profile. The technique of high resolution magic angle proton magnetic resonance spectroscopy can be utilized in enhancing the sensitivity and specificity of sentinel node biopsy and may replace frozen section histopathology
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