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

Abstract

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.

Impact of Deep Learning Assistance on the Histopathologic Review of Lymph Nodes for Metastatic Breast Cancer

“…Surprisingly, a recent analysis of pathologists performing this task with glass slides under simulated time constraints reported a mean sensitivity of only 38% for detecting micrometastases while using H&E sections alone 10. Other data also suggest suboptimal sensitivity and inter-reader variability for identifying micrometastases in sentinel lymph node biopsies, with retrospective studies identifying occult metastases in ∼10% to 15% of cases and changes in nodal status upon expert review in 24% of cases 13–15. Although immunohistochemistry (IHC) is often utilized to improve diagnostic sensitivity, such stains are costly and time consuming, and institution-specific practices for the use of IHC vary considerably.…”

Convolutional neural network initialized active contour model with adaptive ellipse fitting for nuclear segmentation on breast histopathological images

“…4,5 The presence, extent, size, shape, cellular organization, and other morphological appearances of nuclei are important indicators for presence or severity of disease. [6][7][8][9][10][11] In some circumstances, the populations of isolated cells and cell clusters in the tumor 12 may reflect some diagnostic relevance. In breast cancer grading, nuclear atypia refers to how size and appearance of cell nuclei tend to vary in terms of shape and appearance due to irregular chromatin texture and presence of nucleoli.…”