Sentinel Node Metastasis in Patients with Breast Carcinoma Accurately Predicts Immunohistochemically Detectable Nonsentinel Node Metastasis

Chu, Kyo U.; Turner, Roderick R.; Hansen, Nora M.; Brennan, Meghan B.; Giuliano, Armando E.

doi:10.1007/s10434-999-0756-2

Cited by 115 publications

(83 citation statements)

References 16 publications

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“…20,21 However, in patients with SNs found to be positive by H & E staining or IHC, increased scrutiny of NSNs with IHC and additional sections reportedly results in a 10 -20% increase in the detection of NSN metastasis. 21,22 Of the studies analyzed, five used only H & E staining for the evaluation of NSNs. 6,7,9,11,15 In addition to H & E staining, three studies performed IHC and additional sections on NSNs.…”

Section: Resultsmentioning

confidence: 99%

“…As mentioned previously, in patients with H & E-or IHCpositive SNs, increased scrutiny of NSNs with IHC and additional sections is reported to result in a 10 -20% increase in the detection of NSN metastasis. 21,22 Five studies included in the meta-analysis reported the routine use of IHC, three did not routinely use IHC, and in three studies the use of IHC was indeterminate. Including studies that varied with regard to the use of IHC on NSNs appears to decrease the homogeneity of the dataset in the meta-analysis, but excluding studies on this basis would markedly limit the size of the dataset.…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients

Degnim

Griffith

Sabel

et al. 2003

Cancer

139

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BACKGROUNDIn breast carcinoma patients with a positive sentinel lymph node (SN), the value of complete axillary lymph node dissection has been questioned. Multiple published reports have attempted to identify clinicopathologic characteristics of the primary tumor and SN that are associated with an increased likelihood of positive nonsentinel lymph nodes (NSN). Because of differences in lymph node evaluation techniques and limited patient numbers in each study, the authors performed a meta‐analysis to assess the regularity and relative strength of association between various characteristics and the risk of NSN metastasis.METHODSA MEDLINE search identified 15 candidate studies, 11 of which met the criteria for analysis. General elements of the studies, the pathologic characteristics evaluated, and the results for selected characteristics were compared. Original data were abstracted from each study and used to calculate odds ratios. The Mantel–Haenszel common odds ratios were calculated to determine the relative strength of the associations.RESULTSDespite methodologic differences, the correlation between positive NSNs and certain pathologic characteristics was found to be remarkably similar among studies. The 5 individual characteristics found to be associated with the highest likelihood of NSN metastasis are SN metastasis > 2 mm in size, extranodal extension in the SN, tumor size > 2 cm, > 1 positive SN, and lymphovascular invasion in the primary tumor.CONCLUSIONSThere is general concordance among studies regarding the association between pathologic characteristics and NSN metastasis in breast carcinoma patients with a positive SN. The pooled analysis identified those factors with the strongest associations that should be evaluated routinely in SN specimens and included in prospective databases for the development of a predictive model. Cancer 2003. © 2003 American Cancer Society.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients

Degnim

Griffith

Sabel

et al. 2003

Cancer

139

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“…SLN biopsy has a low but measurable falsenegative rate. Furthermore, it provides no information about the presence of additional non-SLN metastasis, which may occur in 40% to 70% of cases (12)(13)(14). Newer, more accurate, and less invasive means of predicting ALN metastasis would greatly improve breast cancer patient management and quality of life.…”

Section: Introductionmentioning

confidence: 99%

Proteomic Profiling of Primary Breast Cancer Predicts Axillary Lymph Node Metastasis

et al. 2006

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To determine if protein expression in primary breast cancers can predict axillary lymph node (ALN) metastasis, we assessed differences in protein expression between primary breast cancers with and without ALN metastasis using surfaceenhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS). Laser capture microdissection was performed on invasive breast cancer frozen sections from 65 patients undergoing resection with sentinel lymph node (SLN) or level I and II ALN dissection. Isolated proteins from these tumors were applied to immobilized metal affinity capture (IMAC-3) ProteinChip arrays and analyzed by SELDI-TOF-MS to generate unique protein profiles. Correlations between unique protein peaks and histologically confirmed ALN status and other known clinicopathologic factors were examined using ANOVA and multivariate logistic regression. Two metalbinding polypeptides at 4,871 and 8,596 Da were identified as significant risk factors for nodal metastasis (P = 0.034 and 0.015, respectively) in a multivariate analysis. Lymphovascular invasion (LVI) was the only clinicopathologic factor predictive of ALN metastasis (P = 0.0038). In a logistic regression model combining the 4,871 and 8,596 Da peaks with LVI, the area under the receiver operating characteristic curve was 0.87. Compared with patients with negative ALN, those with z2 positive ALN or non-SLN metastases were significantly more likely to have an increased peak at 4,871 Da (P = 0.016 and 0.0083, respectively). ProteinChip array analysis identified differential protein peaks in primary breast cancers that predict the presence and number of ALN metastases and non-SLN status. (Cancer Res 2006; 66(24): 11825-30)

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“…[3][4][5] Furthermore, compared with analysis with hematoxylin and eosin (HE) only in ALND specimen, the use of step sectioning and immunohistochemistry in the SLN results in a more accurate histopathologic examination and is associated with a higher detection rate of micrometastases. 6,7 Although the step sectioning and immunohistochemistry can be routinely applied to evaluate one or a few SLN, the systematic use of these techniques is not feasible in the assessment of ALND specimens because of time and financial constraints. However, the prognostic significance and therapeutic implications of SLN micrometastases in terms of axillary recurrence and long-term survival remain a matter of great debate.8 Therefore, the objective of the present prospective study was to evaluate the long-term disease-free and overall survival of patients with SLN micrometastases in whom a completion ALND was systematically omitted.…”

Section: Introductionmentioning

confidence: 99%

Axillary Lymph Node Dissection for Sentinel Lymph Node Micrometastases May Be Safely Omitted in Early-Stage Breast Cancer Patients: Long-Term Outcomes of a Prospective Study

et al. 2009

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Objectives. To evaluate the long-term disease-free and overall survival of patients with sentinel lymph node (SLN) micrometastases, in whom a completion axillary lymph node dissection (ALND) was systematically omitted. Background. The use of step sectioning and immunohistochemistry for SLN analysis results in a more accurate histopathologic examination and a higher detection rate of micrometastases. However, the clinical relevance and therapeutic implications of SLN micrometastases remain a matter of debate. Methods. In this prospective study, 236 SLN biopsies were performed in 234 consecutive early-stage breast cancer patients (T1, T2 ≤ 3 cm, cN0 M0) between 1998 and 2002. The SLN were examined by step sectioning and stained with hematoxylin and eosin and immunohistochemistry. None of the patients with negative SLN or SLN micrometastases (International Union Against Cancer classification, >0.2 to ≤ 2 mm) underwent a completion ALND or radiation to the axilla. Long-term overall and disease-free survivals were compared between patients with negative SLN and those with SLN micrometastases by log rank tests. Results. The SLN was negative in 55% of patients (123 of 224). SLN micrometastases were detected in 27 patients (27 of 224, 12%). After a median followup of 77 months (range, 24-106 months), neither locoregional recurrences nor distant metastases occurred in any of the 27 patients with SLN micrometastases. There were no statistically significant differences for overall (P = 0.656), locoregional (P = 0.174), and axillary and distant disease-free survival (P = 0.15) between patients with negative SLN and SLN micrometastases.Conclusions. This analysis of unselected patients provides evidence that a completion level I and II ALND may be safely omitted in early-stage breast cancer patients with SLN micrometastases.

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Sentinel Node Metastasis in Patients with Breast Carcinoma Accurately Predicts Immunohistochemically Detectable Nonsentinel Node Metastasis

Cited by 115 publications

References 16 publications

Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients

Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients

Proteomic Profiling of Primary Breast Cancer Predicts Axillary Lymph Node Metastasis

Axillary Lymph Node Dissection for Sentinel Lymph Node Micrometastases May Be Safely Omitted in Early-Stage Breast Cancer Patients: Long-Term Outcomes of a Prospective Study

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