A Point of View: Trauma is the Cause of Occult Micrometastatic Breast Cancer in Sentinel Axillary Lymph Nodes

Rosser, Robert J.

doi:10.1046/j.1524-4741.2000.20002.x

Cited by 44 publications

(17 citation statements)

References 15 publications

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“…23,24 Some argue that IHC-detected micrometastases may not be metastases at all. Rosser 8 has suggested that manipulation of the breast either during mammography or at surgery could mechanically disperse tumor cells and that such manipulation explains the IHC-positive SLN. Youngson et al 25,26 have shown that core biopsy can physically displace DCIS into the breast stroma and into lymphatic vessels, artifactually simulating invasion.…”

Section: Discussionmentioning

confidence: 99%

“…Although this methodology has led to validation of the SLN hypothesis, 3 improved staging accuracy, 4 a reduction in false-negative results, 5 and the prediction of non-SLN status in SLN-positive patients, 6,7 it has also fostered controversy regarding the prognostic significance of lymph node micrometastases, especially in patients with small cell clusters or even single tumor cells detected only by IHC. Rosser 8 and Carter et al 9 suggest that these "micrometastases" are not biologic metastases at all, but rather the "benign transport" of breast epithelium by preoperative manipulation of the breast and are devoid of clinical significance. This topic assumes particular importance as SLN biopsy becomes more widespread and as a growing proportion of patients with breast carcinoma (87% in a recent audit from the U.K. 10 ) are diagnosed preoperatively by fine-needle aspiration biopsy (FNAB) or core needle biopsy.…”

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confidence: 99%

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Immunohistochemically detected tumor cells in the sentinel lymph nodes of patients with breast carcinoma

Moore

Thaler

Tan

et al. 2004

Cancer

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BACKGROUNDSentinel lymph node (SLN) biopsy is a new standard of care for patients with breast carcinoma, and allows enhanced pathologic analysis with serial sections and immunohistochemical (IHC) staining for cytokeratins to be performed on a routine basis. However, the significance of SLN micrometastases detected only by IHC is uncertain. Are these tumor cells truly markers of metastatic potential, or simply evidence of passive displacement by preoperative instrumentation of the tumor site? Here we evaluate whether the pattern of SLN metastasis in breast carcinoma is related to the degree of manipulation at biopsy before surgery, independently of other known predictors.METHODSAmong 4016 consecutive eligible patients with breast carcinoma registered in a prospective SLN database at Memorial Sloan Kettering Cancer Center, we noted patient/tumor characteristics, pathologic status of the SLN (negative, positive by hematoxylin and eosin [H&E], or positive only on IHC), and method of previous biopsy (none, fine‐needle aspiration biopsy [FNAB], core needle biopsy, or surgical biopsy).RESULTSMultivariate analysis showed that the likelihood of an H&E‐positive SLN was significantly associated with lymphovascular invasion, tumor size, tumor type, and tumor location, but not with the method of biopsy. In contrast, the likelihood of finding an SLN positive only on IHC was unassociated with any of the four variables above, but was significantly associated with the method of biopsy. After no previous biopsy, FNAB, core needle biopsy, or surgical biopsy, IHC‐positive SLN were present in 1.2%, 3.0%, 3.8%, and 4.6% of patients, respectively (P = 0.002).CONCLUSIONSThese data suggest that the frequency of IHC‐positive SLN in patients with breast carcinoma 1) is unrelated to conventional predictors of lymph node positivity, 2) is increased after instrumentation of the tumor site, and 3) is increased approximately proportionate to the degree of manipulation. A proportion of IHC‐positive SLN were present before biopsy and therefore less likely to be artifactual. Cancer 2004;100:929–34. © 2004 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Immunohistochemically detected tumor cells in the sentinel lymph nodes of patients with breast carcinoma

Moore

Thaler

Tan

et al. 2004

Cancer

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“…Rosser 9 has suggested that IHC-detected cells in SLNs of patients with breast carcinoma represent mechanically displaced epithelial cells resulting from instrumentation or manipulation of the breast during mammography, SLN biopsy, or surgery. Others have shown that preoperative needling procedures, including fine-needle aspiration biopsy (FNAB), core needle biopsy, and needle localization, can displace epithelial fragments into nearby lymphatic channels, which suggests that these cells may then be transported to the lymph nodes.…”

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confidence: 99%

Cytokeratin‐positive cells in sentinel lymph nodes in breast cancer are not random events

King

Ganaraj

Fey

et al. 2004

Cancer

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BACKGROUNDThe incidence of immunohistochemistry (IHC)‐detected epithelial cell displacement in sentinel lymph node (SLN) biopsy is unknown. In the current study, we address this question by examining the pattern of SLN involvement in patients undergoing prophylactic mastectomy (PM) at Memorial Sloan‐Kettering Cancer Center (New York, NY).METHODSBetween January 1999 and January 2003, 5275 patients underwent SLN biopsy. Unilateral or bilateral PM with SLN biopsy was performed in 143 (2.7%) patients, representing 163 PM cases.RESULTSOccult carcinoma was identified in 13 of 163 (8.0%) PM specimens. Two patients with occult invasive carcinoma had positive SLNs (hematoxylin and eosin). In the remaining 150 PM cases without occult carcinoma (130 patients), 89% underwent IHC analysis of the SLNs. Of these 130 patients, 43 (33%) had one or more prior biopsies in their “cancer‐free” breast, a median of 43 days (range, 3–314 days) before PM. A total of 310 SLNs were examined by IHC (mean, 2.3 lymph nodes per PM case). Only 1 of 130 (0.8%) patients without occult carcinoma had an IHC‐positive SLN. This patient had Stage IIIC carcinoma of the contralateral breast. IHC‐positive SLNs were not identified in any of the 43 patients with a history of prior biopsy. Therefore, only 1 IHC‐positive SLN was detected in 310 (0.3%) lymph nodes examined.CONCLUSIONSIHC‐positive cells in SLNs are rare in the absence of cancer and are not the result of previous breast instrumentation. Although the prognostic significance of IHC‐positive cells remains controversial, the current study suggests that they are not random events. Cancer 2004. © 2004 American Cancer Society.

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“…Öte yandan enjeksiyondan hemen sonra SLN disseksiyonuna geçilirse boyanın geçeceği lenfatik kanal da kesilebilmektedir. Aksine enjeksiyon yapıldıktan sonra SLN diseksiyonuna geçme süresi 20 dakikayı geçerse boya SLN'yi geçip tutulum olmayan diğer lenf nodlarını da boyayabilir ve süre uzadığında SLN'deki boyanın renginin açıldığı gözlenir [15]. Bu nedenle boya enjeksiyonundan sonra ideal bekleme süresi 15-20 dakika gibi görülmektedir.…”

Section: Discussionunclassified

Meme kanserinde sentinel lenf nodu uygulaması: 30 vakanın analizi

Köse

Erdem

2017

Archives of Clinical and Experimental Medicine

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Results: Sentinel lymph node involvement was detected in 14 (46.7%) of 30 patients. In the other 16 patients (53.3%), no involvement of the sentinel lymph nodes was detected and six of these patients (37.5%) did not undergo axillary dissection. None of the nine patients (56.2%) without sentinel lymph node involvement had also no axillary involvement. Axillary involvement was detected only in one patient. In our study, 10 patients (62.5%) who had no sentinel lymph node involvement but had axillary dissection showed false negativity in one patient and it was seen that this patient was the first patient to be included in the study. Sentinel lymph node detection rate was 88.2%, accuracy rate was 76.6%, sensitivity rate was 88.2% and false negative rate was 10%. Conclusion: The use of sentinel lymph node biopsy in the surgical treatment of breast cancer is a safe approach.

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A Point of View: Trauma is the Cause of Occult Micrometastatic Breast Cancer in Sentinel Axillary Lymph Nodes

Cited by 44 publications

References 15 publications

Immunohistochemically detected tumor cells in the sentinel lymph nodes of patients with breast carcinoma

Immunohistochemically detected tumor cells in the sentinel lymph nodes of patients with breast carcinoma

Cytokeratin‐positive cells in sentinel lymph nodes in breast cancer are not random events

Meme kanserinde sentinel lenf nodu uygulaması: 30 vakanın analizi

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