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Original Article |
1 Department of Surgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, Michigan 48202
2 Josephine Ford Cancer Center Clinical Trials Office, Henry Ford Health System, Detroit, Michigan 48202
3 Department of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, Michigan 48202
4 Department of Pathology, Henry Ford Health System, Detroit, Michigan 48202
Correspondence: Address correspondence and reprint requests to: S. David Nathanson, MD; E-mail: dnathan1{at}hfhs.org.
Background: Amplification of the protein product of the HER-2/neu oncogene in primary breast cancer specimens is associated with an adverse prognosis. We hypothesized that overexpression of HER-2/neu would predict metastases to the sentinel lymph nodes (SLNs).
Methods: A retrospective review of a prospective nonrandomized evaluation of 1055 clinically node-negative breast cancer patients undergoing 1063 SLN biopsies was performed. HER-2/neu analysis was performed by immunohistochemistry and, in selected cases, by fluorescence in situ hybridization. Clinical, demographic, surgical, radiological, and pathologic data were analyzed by using generalized estimating equations logistic regression models.
Results: Two hundred thirty-two (23.6%) of 985 operations in which the SLN was found at operation resulted in positive nodes. In a multivariate analysis, size (P < .0001) and HER-2/neu overexpression (P = .026) were independent predictors of SLN metastasis.
Conclusions: Size is a known predictor of SLN metastasis in the modern SLN era, as it was in the pre-SLN eras. HER-2/neu was found to be significantly predictive of SLN metastasis in our study. We anticipate a future when even the relatively minor procedure of SLN biopsy might be avoided with the predictive information gained from studying the pathology and molecular markers of primary breast cancers.
Key Words: Sentinel lymph nodes • Breast cancer • HER-2/neu • Prediction
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