Impact and Outcomes of Routine Microstaging of Sentinel Lymph Nodes in Breast Cancer: Significance of the pN0(i+) and pN1mi Categories

Pugliese, Matthew S.; Beatty, J. David; Tickman, Ronald; Allison, Kimberly H.; Atwood, Mary; Szymonifka, Jackie; Arthurs, Zachary M.; Huynh, Paul; Dawson, John H.

doi:10.1245/s10434-008-0121-x

Cited by 36 publications

(19 citation statements)

References 21 publications

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“…However, Fig. 3b suggests that even pN micro and pN ITC are risk factors, even if only the sentinel LN (SLN) is involved [8,26,[47][48][49][50][51]. Therefore, a macroscopic pN0 cohort in Fig.…”

Section: Pln Do Not Initiate Distant Metmentioning

confidence: 97%

Positive lymph nodes do not metastasize

Engel¹,

Emeny²,

Hölzel

2011

Cancer Metastasis Rev

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Our understanding of the role of lymph nodes (LN) in the metastasization process (MET) is marginal. Positive LNs (pLN) are the most important prognostic factor and lymph node dissection (LND) is still standard practice in primary treatment. However, up to now, there is almost no evidence that elective LND has a survival benefit. Based on many clinical and experimental findings, we propose that tumor foci in regional LN are incapable of metastasization and can therefore not infiltrate further LN and organs. Available data demonstrate a very early infiltration of MET capable tumor cells from the primary tumor into regional LN, and thereafter an increased probability of subsequent LN infiltrations. Disparate growth rates of the first versus subsequent infiltrating tumors as well as the asymptotic growth and prognosis of large tumor foci in LN explain many clinical observations for solid tumors. The consequence of the hypothesis "pLN do not metastasize" would impact clinical treatment and research and contribute to understanding the mounting evidence against LND.

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Section: Pln Do Not Initiate Distant Metmentioning

confidence: 97%

Positive lymph nodes do not metastasize

Engel¹,

Emeny²,

Hölzel

2011

Cancer Metastasis Rev

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“…In eight studies, the presence of isolated tumor cells did not seem to influence prognosis [16][17][18][19][21][22][23][24]. In one of these, however, overall survival was lower in patients who had not undergone an additional axillary lymph node dissection as compared with patients who had undergone an axillary lymph node dissection (P = 0.02) [17].…”

Section: Discussionmentioning

confidence: 96%

Prognostic impact of isolated tumor cells in breast cancer axillary nodes: single tumor cell(s) versus tumor cell cluster(s) and microanatomic location

Vestjens

Boer

Diest

et al. 2011

Breast Cancer Res Treat

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In breast cancer, it has been shown that pN0(i+) and pN1mi have a comparable negative impact on disease-free survival, compared with pN0. However, pN0(i+) is considered to be a heterogeneous group. We determined the effect of metastatic size and microanatomic location within the pN0(i+) group on breast cancer recurrence. We included all Dutch breast cancer patients diagnosed in 1998-2005 with favorable primary tumor characteristics and a final nodal status of pN0(i+). For this analysis, only patients without adjuvant systemic therapy were eligible (n = 513). Presence of single tumor cells versus cell clusters, metastatic size and microanatomic location were recorded. Primary endpoint was disease-free survival. Analyses were adjusted for age at diagnosis, tumor size, tumor grade, axillary treatment and hormone receptor status. The 5-year disease-free survival of patients with single tumor cell(s) (n = 93) was 78.6% and with tumor cell cluster(s) (n = 404) 77.1%. The hazard ratio for disease events was 1.05 (95% CI 0.63-1.76) for cell cluster(s) compared with single cell(s). In a Cox regression model, doubling of metastatic tumor size corresponded to a hazard ratio of 1.21 (95% CI 1.02-1.43). The adjusted hazard ratio was 0.90 (95% CI 0.54-1.50) for parenchymal (n = 112) versus sinusoidal location (n = 395). Single tumor cells bear similar prognostic information as small tumor cell clusters, even though results do suggest that within the pN0(i+) group, increasing size of nodal involvement is associated with reduced survival. Microanatomic location does not seem to have prognostic relevance.

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“…Pugliese et al [47] identified 86 patients with SLN ITC within their prospective registry. After a median follow-up of 45.4 months, no statistically significant difference was noted in overall survival (OS) or RFS when comparing node-negative, SLN ITC and SLN MM patients.…”

Section: Significance Of Isolated Tumour Cells Evidence Againstmentioning

confidence: 99%