Detection and significance of occult metastases in node-negative breast cancer

Hainsworth, P. J.; Tjandra, Joe J.; Stillwell, R. G.; Machet, David; Henderson, Michael A.; Rennie, G. C.; McKenzie, Ian F. C.; Bennett, R. C.

doi:10.1002/bjs.1800800417

Cited by 229 publications

(122 citation statements)

References 22 publications

Supporting

Mentioning

118

Contrasting

Unclassified

Order By: Relevance

“…However, 15 -30% of node-negative patients suffer from a recurrence within 5 years (Fisher et al, 1983;Giuliano et al, 1995;Saimura et al, 1999). Previous studies have reported that routine haematoxylin and eosin (H&E) staining analysis of axillary lymph nodes may miss micrometastases in the range of 9 -25% of patients that can be readily detected by serial sectioning (International (Ludwig) Breast Cancer Study Group, 1990;Mascarel et al, 1992;Nasser et al, 1993) and immunohistochemical staining (Mascarel et al, 1992;Hainsworth et al, 1993;Nasser et al, 1993;Cote et al, 1999). However, these methods are too cumbersome, too time-consuming, and too costly to be used in routine examinations (Lockett et al, 1998).…”

mentioning

confidence: 99%

Quantitative evaluation of metastases in axillary lymph nodes of breast cancer

et al. 2003

View full text Add to dashboard Cite

We have established a highly sensitive and quantitative reverse transcriptase -polymerase chain reaction (RT -PCR) method to detect axillary lymph node metastases of breast cancer. Amplifying cytokeratin 19 (CK19) mRNA transcripts using real-time TaqMan PCR made it possible to quantify axillary metastatic burden. Metastases in 358 axillary lymph nodes obtained from 23 breast cancers of 22 patients were investigated by conventional haematoxylin and eosin (H&E) staining, immunohistochemical staining and quantitative RT -PCR assay. The detection rates of axillary lymph node metastasis using H&E staining, immunohistochemistry and RT -PCR assay were 4.5, 5.9 and 13.1%, respectively. RT -PCR assay was the most sensitive of these three methods for detecting lymph node metastases. Cytokeratin 19 mRNA expression values of both histologically and immunohistochemically positive lymph nodes were significantly higher than the values for lymph nodes judged to be negative by both histological and immunohistochemical methods (Po0.0001), and those of histologically negative, but immunohistochemically positive lymph nodes were significantly higher than the values for lymph nodes judged to be negative by both histological and immunohistochemical methods (Po0.0001). Furthermore, metastatic rates of sentinel nodes were higher than the rates of nonsentinel lymph nodes as measured by all three methods. These results indicate that quantitative RT -PCR assay is a sensitive and reliable method for detecting lymph node metastasis. Furthermore, quantification of metastases in sentinel lymph nodes by quantitative RT -PCR assay may be useful to assess the entire axillary burden of breast cancer patients.

show abstract

mentioning

confidence: 99%

Quantitative evaluation of metastases in axillary lymph nodes of breast cancer

et al. 2003

View full text Add to dashboard Cite

show abstract

“…One possible explanation for this phenomenon is that traditional histological evaluation of ALND specimens underestimates the true rate of lymph node metastases (10)(11)(12)(13)(14). Axillary nodal status may be important in selecting patients particularly with small (pT1) tumors for adjuvant systemic therapy (4,20).…”

Section: Discussionmentioning

confidence: 99%

“…Axillary nodal status may be important in selecting patients particularly with small (pT1) tumors for adjuvant systemic therapy (4,20). Serial or step sectioning substantially improves the staging accuracy of ALND, and this may be further improved by IHC (10)(11)(12)(13)(14). Detailed pathological examination of all nodes removed by ALND is clinically unfeasible, but a focused and detailed evaluation of the nodes most likely to harbor metastasis removed by SLNB may be feasible and cost-effective (18).…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, routine histological evaluation of ALND specimens by hematoxylin and eosin (H&E) staining of sections from one level of each node underestimates the true rate of node-positive disease. Careful reevaluation of apparently negative lymph nodes by serial sectioning, immunohistochemistry (IHC) or both demonstrated the presence of occult metastases in 9-33% of patients in various studies (10)(11)(12)(13)(14). Most of these studies have shown that micrometastatic nodal disease is an independent predictor of decreased overall and/or disease-free survival (11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Immunohistochemistry and Reverse Transcriptase Polymerase Chain Reaction on Sentinel Lymph Nodes can Improve the Accuracy of Nodal Staging in Breast Cancer Patients

et al. 2001

View full text Add to dashboard Cite

In this study the nodal staging sensitivity of sentinel lymph node biopsy (SLNB) with detailed pathological and molecular biological examination has been investigated and compared to that of axillary lymph node dissection (ALND) with routine histological evaluation. Sentinel lymph nodes (SLNs) were removed by the dual-agent injection technique in 68 patients with primary, clinically node-negative breast cancer. Forty-seven patients had negative SLNs according to hematoxylin and eosin (H&E) staining. These H&E-negative SLNs were serially sectioned and examined at 250 µm levels by anticytokeratin immunohistochemistry (IHC). In 14 patients the SLNs were also investigated by cytokeratin 20 (CK20) reverse transcriptase polymerase chain reaction (RT-PCR). SLNB with IHC increased the node-positive rate by 26% (by 40% in tumors less than or equal to 2 cm in size (pT1) and by 9% in tumors more than 2 cm but less than or equal to 5 cm in size (

show abstract

“…Some studies on the prognostic significance of micrometastases in ALND before introduction of the sentinel node biopsy showed that patients with axillary micrometastases had higher recurrence rates and lower overall survival [11][12][13][14], others however demonstrated no such difference [15,16]. Although most studies with larger sample sizes and longer follow-up tend to show a negative effect of micrometastatic disease on overall and disease free survival [17,18], comparison between these retrospective studies and extrapolation to patients with SNB is hampered by different inclusion criteria and large technical variances in the assessment of micrometastases.…”

Section: Introductionmentioning

confidence: 99%