Annals of Surgical Oncology, Vol 4, Issue 6 447-451, Copyright © 1997 by Society of Surgical Oncology

ARTICLES

Prognostic significance of occult lymph node metastases in node-negative breast cancer

S. E. Clare, S. F. Sener, W. Wilkens, R. Goldschmidt, D. Merkel and D. J. Winchester
Department of Surgery, Evanston Hospital, Illinois 60201, USA.

BACKGROUND: Lymph node status, established by a single hematoxylin and eosin (H&E) section from each node, remains an important prognostic indicator in patients with breast cancer, but used alone it is insufficient to identify patients who will develop metastatic disease. This study was conducted to assess the significance of detecting occult metastases in 86 patients with breast cancer originally reported to be histologically node negative. None of the patients received adjuvant systemic therapy. METHODS: Five additional levels from formalin-fixed, paraffin-embedded nodes were examined at 150-microns intervals with H&E staining and a cocktail of antikeratin antibodies (AE1/AE3) recognizing low molecular weight acidic keratins. RESULTS: Nodes from 11 (12.8%) of 86 patients contained occult metastases. All metastases identified by cytokeratin antibody were also detected in H&E-stained sections. With median follow-up of 80 months, distant metastases occurred in five of 11 occult node-positive patients (45%) and 13 of 75 patients whose nodes were negative on review (17%). Median time to recurrence was 89 months for occult node-positive patients and not yet reached for node-negative patients (p = 0.048). The disease-specific 5-year survival rate was 90% for occult node-positive patients and 95% for node-negative patients. CONCLUSIONS: The presence of occult metastases shortened the disease-free interval and suggested that more diligent axillary staging would more accurately identify patients who would benefit from systemic adjuvant treatment.

This article has been cited by other articles:

				E. M. Sevick-Muraca, R. Sharma, J. C. Rasmussen, M. V. Marshall, J. A. Wendt, H. Q. Pham, E. Bonefas, J. P. Houston, L. Sampath, K. E. Adams, et al. Imaging of Lymph Flow in Breast Cancer Patients after Microdose Administration of a Near-Infrared Fluorophore: Feasibility Study Radiology, March 1, 2008; 246(3): 734 - 741. [Abstract] [Full Text] [PDF]

				P. Querzoli, M. Pedriali, R. Rinaldi, A. R. Lombardi, E. Biganzoli, P. Boracchi, S. Ferretti, C. Frasson, C. Zanella, S. Ghisellini, et al. Axillary Lymph Node Nanometastases Are Prognostic Factors for Disease-Free Survival and Metastatic Relapse in Breast Cancer Patients. Clin. Cancer Res., November 15, 2006; 12(22): 6696 - 6701. [Abstract] [Full Text] [PDF]

				G.-C. Hsu, C.-H. Ku, J.-C. Yu, C.-B. Hsieh, C.-P. Yu, and T.-Y. Chao Application of intraoperative ultrasound to nonsentinel node assessment in primary breast cancer. Clin. Cancer Res., June 15, 2006; 12(12): 3746 - 3753. [Abstract] [Full Text] [PDF]

				M. T. Becker, C. G. Shores, K. K. Yu, and W. G. Yarbrough Molecular Assay to Detect Metastatic Head and Neck Squamous Cell Carcinoma Arch Otolaryngol Head Neck Surg, January 1, 2004; 130(1): 21 - 27. [Abstract] [Full Text] [PDF]

				F J Fleming, D Kavanagh, T B Crotty, C M Quinn, E W McDermott, N O'Higgins, and A D K Hill Factors affecting metastases to non-sentinel lymph nodes in breast cancer J. Clin. Pathol., January 1, 2004; 57(1): 73 - 76. [Abstract] [Full Text] [PDF]

				M A den Bakker, A van Weeszenberg, A Y de Kanter, F H Beverdam, C Pritchard, T. H van der Kwast, and M Menke-Pluymers Non-sentinel lymph node involvement in patients with breast cancer and sentinel node micrometastasis; too early to abandon axillary clearance J. Clin. Pathol., December 1, 2002; 55(12): 932 - 935. [Abstract] [Full Text] [PDF]

				S. E. Singletary, C. Allred, P. Ashley, L. W. Bassett, D. Berry, K. I. Bland, P. I. Borgen, G. Clark, S. B. Edge, D. F. Hayes, et al. Revision of the American Joint Committee on Cancer Staging System for Breast Cancer J. Clin. Oncol., September 1, 2002; 20(17): 3628 - 3636. [Abstract] [Full Text] [PDF]

				M. Chen, S. Palleschi, A. Khoynezhad, G. Gecelter, C. P. Marini, and H. H. Simms Role of Primary Breast Cancer Characteristics in Predicting Positive Sentinel Lymph Node Biopsy Results: A Multivariate Analysis Arch Surg, May 1, 2002; 137(5): 606 - 610. [Abstract] [Full Text] [PDF]

				M. J. Liptay, S. C. Grondin, W. A. Fry, C. Pozdol, D. Carson, C. Knop, G. A. Masters, R. M. Perlman, and W. Watkin Intraoperative Sentinel Lymph Node Mapping in Non-Small-Cell Lung Cancer Improves Detection of Micrometastases J. Clin. Oncol., April 15, 2002; 20(8): 1984 - 1988. [Abstract] [Full Text] [PDF]

				S. L. Wong, M. J. Edwards, C. Chao, T. M. Tuttle, R. D. Noyes, C. Woo, P. B. Cerrito, K. M. McMasters, and for the University of Louisville Breast Cancer Sen Predicting the Status of the Nonsentinel Axillary Nodes: A Multicenter Study Arch Surg, May 1, 2001; 136(5): 563 - 568. [Abstract] [Full Text] [PDF]

				P. Morgagni, L. Saragoni, S. Folli, M. Gaudio, E. Scarpi, F. Bazzocchi, G. A. Marra, and A. Vio Lymph Node Micrometastases in Patients With Early Gastric Cancer: Experience With 139 Patients Ann. Surg. Oncol., March 1, 2001; 8(2): 170 - 174. [Abstract] [Full Text] [PDF]

				M. J. Liptay, G. A. Masters, D. J. Winchester, B. L. Edelman, B. J. Garrido, T. R. Hirschtritt, R. M. Perlman, and W. A. Fry Intraoperative radioisotope sentinel lymph node mapping in non-small cell lung cancer Ann. Thorac. Surg., August 1, 2000; 70(2): 384 - 389. [Abstract] [Full Text] [PDF]

				K. M. McMasters, A. E. Giuliano, M. I. Ross, D. S. Reintgen, K. K. Hunt, D. R. Byrd, V. S. Klimberg, P. W. Whitworth, L. C. Tafra, and M. J. Edwards Sentinel-Lymph-Node Biopsy for Breast Cancer -- Not Yet the Standard of Care N. Engl. J. Med., October 1, 1998; 339(14): 990 - 995. [Full Text]

				E. C. Hsueh and A. E. Giuliano Sentinel Lymph Node Technique for Staging of Breast Cancer Oncologist, June 1, 1998; 3(3): 165 - 170. [Abstract] [Full Text]