Occult Axillary Lymph Node Metastases in Breast Cancer Do Matter

Abstract

Axillary lymph node status is one of the most powerful prognostic factors for patients with breast cancer and is often critical in stratifying patients into adjuvant treatment regimens. In 203 apparently node-negative cases of breast cancer, a combination of immunohistochemical staining and step-sectioning identified occult metastases in 25% of cases. Ten-year follow-up information is available for these patients. Histologic features of the primary tumor and immunohistochemical staining for estrogen receptor, progesterone receptor, Her-2, and p53 were also evaluated. With multivariate analysis, both occult metastases and higher histologic grade of the primary tumor were independent predictors of disease-free survival. Histologic grade was the only significant independent predictor of overall survival. Estrogen receptor, progesterone receptor, Her-2, and p53 status did not predict the presence of metastases or survival when all tumor types were considered together. Metastases >0.5 mm significantly predicted a poorer disease-free survival when invasive ductal carcinomas were considered alone. Histologic grade was significantly associated with disease-free survival in the premenopausal and perimenopausal patients but not in the postmenopausal patients. The presence of occult metastases approached significance for overall survival in the premenopausal and perimenopausal patients but not in the postmenopausal patients.

Axillary Lymph Node Nanometastases Are Prognostic Factors for Disease-Free Survival and Metastatic Relapse in Breast Cancer Patients

“…Treatment of pN 1 patients was much more frequent (80% of the cases) and a correspondingly larger effect is expected. This might have contributed to the flattening of the CCI curves of pN 1 patients at long follow-up times, which is consistent with previous observations (7).…”

The relevance of occult axillary micrometastasis in ductal carcinoma in situ

“…However, more recently, studies have presented data refining that measurement and showing that cutoff points of 0.2 and 0.5 mm are associated with greater clinicopathologic significance. 6 This is quite understandable because more sophisticated screening techniques are leading to earlier and smaller primary tumors being detected with greater frequency. Yet, in 3,15,16,18,19 However, now that the techniques to identify such foci are available, we must determine the significance of miniscule disease.…”

“…Previous studies have demonstrated a true incidence of lymph node involvement in the primary stages of breast carcinoma, with rates that differ from pTis through pT1a, pT1b, pT1c, pT2, pT3, and pT4 lesions. 6,8,10,15,19 In addition, lymphovascular invasion and tumor fibrosis have also been associated with the increased incidence of tumor deposition in lymph nodes. 20 Accordingly, adjuvant therapy has been tailored based on these findings.…”

“…5 The presence of tumor deposits in axillary lymph nodes, detected routinely by a single microscopic section stained with hematoxylin and eosin (H & E), has been shown to be a harbinger of more to expect. 6 Quantification of tumor in lymph nodes has been studied. Deposits measuring less than 0.2 cm have been labeled as micrometastases and tumor foci larger than 0.2 cm have been labeled as macrometastases.…”

A Macrophage-Specific Fluorescent Probe for Intraoperative Lymph Node Staging

“…The nodal status of cancer is an important prognostic indicator for patients diagnosed with many forms of solid cancers (14)(15)(16)(17)(18). The SLN concept states that, if the first lymph node to receive lymphatic drainage from a tumor site does not contain tumor cells, the tumor is not likely to have metastasized to the lymphatic system.…”