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Occult metastases in the sentinel lymph nodes of patients with early stage breast carcinoma
Author(s) -
Dowlatshahi Kambiz,
Fan Ming,
Bloom Kenneth J.,
Spitz Daniel J.,
Patel Samir,
Snider Howard C.
Publication year - 1999
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19990915)86:6<990::aid-cncr14>3.0.co;2-d
Subject(s) - lymph , medicine , axillary lymph nodes , pathology , cytokeratin , h&e stain , lymph node , sentinel lymph node , metastasis , carcinoma , metastatic carcinoma , micrometastasis , breast carcinoma , stage (stratigraphy) , occult , breast cancer , staining , immunohistochemistry , cancer , biology , paleontology , alternative medicine
BACKGROUND Thirty percent of lymph node negative patients with operable breast carcinoma experience disease recurrence within 10 years. Retrospective serial sectioning of axillary lymph nodes has revealed undetected metastases in 9–30% of these patients. These occult metastases have been shown to have an adverse effect on survival. Serial sectioning (SS) is impractical for all axillary lymph nodes harvested from Levels I and II, but it is feasible if applied only to sentinel lymph nodes. METHODS Sentinel lymph nodes from 52 patients with invasive breast carcinoma were cut at 2 mm intervals, fixed in 10% formalin, and embedded in paraffin. Sections were taken from the blocks, stained with hematoxylin and eosin (H & E), and compared with cytokeratin‐stained sections taken at 0.25 mm intervals throughout the entire blocks. RESULTS Tumor metastases were found in 6 patients (12%) when the sentinel lymph nodes were sectioned at 2 mm intervals and stained with H & E, compared with 30 patients (58%) when the same lymph nodes were serially sectioned at 0.25 mm intervals and stained with cytokeratin. Of 24 patients whose metastases were detected by SS and cytokeratin staining, 12 had isolated tumor cells and 12 had colonies of several thousand malignant cells. CONCLUSIONS Routine histologic examination of axillary lymph nodes, including sentinel lymph nodes, in cases of breast carcinoma significantly underestimates lymph node metastases. This deficiency may be overcome by SS of the entire lymph nodes and staining with a specific monoclonal antibody. The percentage of patients found to have colonies of cells that were missed by routine sectioning corresponds closely to the percentage of “lymph node negative” patients who would be expected to relapse. The true clinical significance of these occult metastases will be determined by long term follow‐up. [See editorial on pages 905–7, this issue.] Cancer 1999;86:990–6. © 1999 American Cancer Society.