The Clinical Significance of Sentinel Lymph Node Micrometastases in Breast Cancer
Authors:
P. Strnad 1; Lukáš Rob 1; P. Škapa 2; H. Stankušová 3; K. Michalová 4; J. Chod 1
Authors‘ workplace:
Gynekologicko-porodnická klinika 2. LF UK a FN Motol, Praha, přednosta doc. MUDr. Lukáš Rob, CSc.
1; Ústav patologie a molekulární medicíny 2. LF UK a FN Motol, Praha
2; Radioterapeuticko-onkologické oddělení 2. LF UK a FN Motol, Praha
3; Klinika nukleární medicíny 2. LF UK a FN Motol, Praha
4
Published in:
Ceska Gynekol 2008; 73(6): 360-364
Overview
Objective:
The advent of sentinel lymph node biopsy and improvements in histopathological and immunohistochemical analysis has increased the rate at which micrometastases are identified. However their significance has been the subject of much debate. Published studies have reported divergent results regarding the significance and implications of axillary lymph node micrometastases. Some studies demonstrate no associations, whilst others have found these to be indicators of poor prognosis, associated with non-SLN involvement, in addition to local and distant failure. The objective of our study was to evaluate the impact of sentinel lymph node micrometastatic cancer to prognosis of the disease.
Design:
Retrospective study.
Setting:
Departments of Gynecology and Obstetrics, Faculty Hospital, Prague.
Methods:
From January 2000 to December 2006 in 87 cases with sentinel axillary node negative cancer we reexamined the axillary tissue blocks by serial sectioning, haematoxilin-eosin staining and immunohistochemistry. Additional 15 cases of micrometastatic sentinel node involvement detected by frozen section were included. The overall and disease free survivals of patients with sentinel negative status (N0-67 cases) and with sentinel node micrometastases (Nmic-35 cases) were evaluated. The median follow-up was 60 months (24-96 months).
Results:
Micrometastases (Nmic) were found in 20 cases (23%). From the group of 67 nodes negative patients (N0) in 7 cases (10.5%) developed tumor recurrence and from the group of 35 Nmic in 5 cases developed five tumor recurrences (13.3%). In the group of N0 patients developed 2 regional recurrences and 3 patients died, but 2 patients died of other causes. In the group of Nmic developed one regional recurrence and 3 patients died of generalization of disease.
Conclusion:
Our study demonstrated that the presence of sentinel node micrometastases is associated with risk of development of distant metastases and generalization of the disease, but not with higher risk of regional recurrence.
Key words:
micrometastases, sentinel lymph node, breast cancer.
Sources
1. Alix-Panabieres, C., Muller, V., Pantel, K. Current status in human breast cancer micrometastases. Curr Opin Oncol, 2007, 19, 6, p. 1463-1472.
2. Bulte, CS., van der Heiden-van der Loo, M., Hennipman, A. Axillary recurrence rate after tumour negative and micrometastatic positive sentinel node procedures in breast cancer patients, a population based multicenter study. Eur J Surg Oncol, 2008, (Epub ahead of print).
3. Cady, B. Should positive sentinel node cases have a further axillary dissection? Breast Cancer Online, 2006, 9, 8, p. 1-5, e32.
4. Carcoforo, P., Maestroni, U., Querzoli, P., et al. Primary breast cancer features can predict additional lymph node involvement in patients with sentinel node micrometastases. World J Surg, 2006, 30, 9, p. 1653-1657.
5. Colleoni, M., Rotmensz, N., Peruzzoti, G. Size of breast cancer metastases in axillary lymph nodes: clinical relevance of minimal lymph node involvement. J Clin Oncol, 2005, 23, p. 1379-1389.
6. Cox, CE., Kiluk, JV., Riker, AI., et al. Significance of sentinel lymph node micrometastases in human breast cancer. J Am Coll Surg, 2008, 206, 2, p. 261-268.
7. Diaz, NM., Cox, CE., Ebert, M., et al. Benign mechanical transport of breast epithelial cells to sentinel lymph nodes. Am J Surg Pathol, 2004, 28, 12, p. 1641-1645.
8. Dowlatshahi, K., Fan, M., Snider, HC., Habib, F. Lymph node micrometastases from breast carcinoma. reviewing the dilemma. Cancer, 1997, 80, 7, p. 1188-1197.
9. Van Deurzen, CH., Hobbelink, MG., Seldenrijk, CA., et al. Predictive value of tumor load in breast cancer sentinel lymph nodes for second echelon lymph node metastases. Cell Oncol, 29, 6, 2007, p. 497-505.
10. Gobardhan, PD., Elias, SG., Madsen, EVE., et al. Prognostic value of micrometastases in sentinel lymph nodes of patients with breast carcinoma: a cohort study, Ann Oncol, 2008, (Epub ahead of print).
11. Houvenaeghel, G., Nos, C., Mignotte, H., et al. Micrometastases in sentinel lymph node in a multicentric study: predictive factors of nonsentinel lymph node involvement – Groupe des Chirugiens de la Federation des Centres de Lutte Contre le Cancer. J Clin Oncol, 2006, 24, 12, p. 1814-1822.
12. Chapgar, A., Middleton, LP., Sahin, AA., et al. Clinical outcome of patients with lymph node-negative breast carcinoma who have sentinel lymph node micrometastases detected by immunohistochmistry. Cancer, 2005, 104, 8, p. 1581-1586.
13. Kahn, HJ., Hanna, WM., Chapman, JA., et al. Biological significance of occult micrometastases in histologically negative axillary lymph nodes in breast cancer patients using the recent American Joint Committee on Cancer breast cancer staging system. Breast J, 2006, 12, 4, p. 294-301.
14. Kamath, VJ., Giuliano, R., Dauway, EL., et al. Characteristics of the sentinel node in breast cancer predict further involvement of higher-echelon nodes in the axilla: a study to evaluate the need for complete axillary lymph node dissection. Arch Surg, 2001, 136, 6, p. 688-692.
15. Kuijt, GP., Voogd, AC., van de Poll-Franse, LV., et al. The prognostic significance of axillary lymph-node micrometastases in breast cancer patients. Eur J Surg Oncol, 2005, 31, 5, p. 500-505.
16. Langer, I., Marti, WR., Guller, U., et al. Axillary recurrence rate in breast cancer patients with negative sentinel node (SLN) or SLN micrometastases: prospective analysis of 150 patients after SLN biopsy. Ann Surg, 2005, 241, 1, p. 152-158.
17. De Mascarel, I., MacGrogan, G, Debled, M., et al. Distinction between isolated tumor cells and micrometastases in breast cancer is it reliable and useful? Cancer, 2008, 112, 8, p. 1672-1678.
18. Menes, TS., Tartter, PI., Mizrachi, H., et al. Breast cancer patients with pN(i+) and pN1(mi) sentinel nodes have high rate of nonsentinel node metastases. J Am Coll Surg, 2005, 200, 3, p. 323-327.
19. Millis, RR., Springall, R., Lee, AH., et al. Occult axillary lymph node metastases are of no prognostic significance in breast cancer. Brit J Cancer, 2002, 86, 3, p. 396-401.
20. Moore, KH., Thaler, HT., Tan, LK., et al. Immunohistochemically detected tumor cells in the sentinel lymph nodes of patients with breast carcinoma: biologic metastasis or procedural artifact? Cancer, 2004, 100, 5, p. 929-934.
21. Querzoli, P., Pedriali, M., Rinaldi, R., et al. Axillary lymph node nanometastases are prognostic factors for disease-free survival and metastatic relapse in breast cancer patients. Clin Cancer Res, 2006, 12, 22, p. 6696-6701.
22. Susnik, B., Frkovic-Grazio, S., Bracko, M. Occult micrometastases in axillary lymph nodes predict subsequent distant metastases in stage I breast cancer: a case-control study with 15-year follow up. Ann Surg. Oncol, 2004, 11, 6, p. 553-554.
23. Tan, LK., Giri, D., Hummer, AJ., et al. Occult axillary node metastases in breast cancer are prognostically significant: results in 368 node-negative patients with 20-year follow-up. J Clin Oncol, 2008, 26, 110, p. 1803-1809.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2008 Issue 6
Most read in this issue
- Dilemma of the Results Interpretation of Molecular Genetic Analysis with a Focus on CFTR Gene Mutations in Men with Reproductive Disorders and in Gamete Donors
- Validity of Hysteroscopy in Clinical Setting: Single Centre Analysis of 605 Consecutive Hysteroscopies
- The Clinical Significance of Sentinel Lymph Node Micrometastases in Breast Cancer
- Molecular Biology of Preinvasive and Invasive Breast Tumors