A Note of Caution

Abstract

Sentinel lymph node biopsy is the current standard procedure used to stage patients with breast cancer. The best histological method in evaluating sentinel nodes is highly debated among institutions and is thus not standardized. The optimal histological analysis is a balance between comprehensive evaluation of the sentinel nodes and cost effectiveness. One commonly used approach is serial sectioning and alternately staining with hemotoxylin and eosin and AE1/AE3 cytokeratin immunohistochemistry analysis. We report 2 cases of metastatic carcinoma demonstrating negative staining for AE1/AE3. This observation highlights a rare but potential pitfall to this commonly used strategy in assessing sentinel lymph node biopsies in breast cancer.

The Pan-Cytokeratin Staining Intensity and Fractal Computational Analysis of Breast Tumor Malignant Growth Patterns Prognosticate the Occurrence of Distant Metastasis

“…This study was designed to compensate for the possible variation in the expression of individual cytokeratins by choosing the AE1/AE3 antibody preparation with a wide range of binding to 13 cytokeratins. The observed lower pan-cytokeratin staining intensity in high-risk tumors was in agreement with the previous report of complete loss of such staining for malignant cells disseminated to lymph nodes, probably associated with cell dedifferentiation (27). The advantage of the current study was its assessment of the pan-cytokeratin staining intensity, however, malignant cells not stained by pan-cytokeratin could not be quantified.…”

Immunocytochemical markers, molecular testing and digital cytopathology for aspiration cytology of metastatic breast carcinoma

“…23,24 It has to be stressed that epithelial markers should not be interpreted in isolation, and cytomorphologic correlation to the primary tumour is necessary for correctly identifying these non-lesional epithelial cells. Additionally, negative staining does not completely exclude metastasis, as cytokeratin-negative cases of axillary metastasis have been reported, 25 which may be due incomplete immunoreactivity in poorly differentiated and metaplastic carcinoma compounded by limited biopsy sampling. 25,26…”

“…Additionally, negative staining does not completely exclude metastasis, as cytokeratin-negative cases of axillary metastasis have been reported, 25 which may be due incomplete immunoreactivity in poorly differentiated and metaplastic carcinoma compounded by limited biopsy sampling. 25,26…”