Histopathologic characteristics of the primary tumor in breast cancer patients with isolated tumor cells of the sentinel node

ArticleinSurgery 144(4):518-24; discussion 524 · October 2008with5 Reads
DOI: 10.1016/j.surg.2008.06.006 · Source: PubMed
Clinicians often rely on primary tumor characteristics to decide on adjuvant treatment for patients with breast cancer with isolated tumor cells (ITC) in the sentinel lymph node. The purpose of this study was to determine if there is a significant difference in primary tumor characteristics between ITC and other nodal groups. Patients undergoing sentinel lymphadenectomy were divided into 3 groups: N0, no metastases; ITC, metastasis less than 0.2 mm; and micro- or macrometastases (MM), metastasis greater than 0.2 mm. The chi-square test and analysis of variance were used. A total of 552 patients underwent sentinel lymphadenectomy; 197 (36%) had tumor-positive sentinel lymph nodes. Of these, 35 (18%) were classified as ITC and 162 (82%) as MM. When primary tumor characteristics were compared, the ITC group had significantly more lymphovascular invasion and higher proliferative rate than the N0 group (P < .05) and significantly less lymphovascular invasion, lower proliferative rate, and smaller tumor size (P < .05) than the MM group. There were no significant differences in the age, hormone receptor status, histologic type, or tumor grade among the patient groups. Proliferation and lymphovascular invasion of the primary tumor are significantly different between the ITC, N0, and MM groups suggesting that ITC tumors may have different biology than the N0 or MM tumors.
    • "The Norwegian Breast Cancer Group have decided that patients with SN metastasis ≤ 2mm should avoid having ALND if breast preserving therapy including radiotherapy to the breast and lower axilla is carried out [2]. Similar to Hulvat et al. [20], we did not find any correlation between receptor positivity and/or histology grade with either SN or non- SN metastasis. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Sentinel node biopsy (SNB) was introduced at Ullevaal University Hospital in 2000. This article presents results from the first ten years use of the method. Material and Methods: A prospective registration of 2762 patients was made from 2000 through 2009. Results: The median follow-up time was 51 months. The overall detection rate was 93%. 36% of the patients with positive SNs had non-sentinel metastases. These were significantly associated with a macrometastatic SN and a primary tumour > 20 mm. 18% of patients with sentinel metastasis ≤ 2 mm had non-sentinel metastases. 14 patients with negative SN (0.7%) developed axillary recurrence. 32% with a preoperative diagnosis of ductal carcinoma in situ (DCIS) were upstaged to infiltrating carcinoma on final histology. None of the patients with pure DCIS had positive SNs. Conclusion: Few late events (0.7%) in SN negative axillas demonstrate the safety of the technique.
    Full-text · Article · Jan 2012
  • Article · Apr 2009
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose: Sentinel lymph node (SLN) biopsy has replaced unnecessary axillary dissection in breast cancer surgery except when the nodes are positive for macrometastasis. But guidelines for isolated tumor cells (ITCs) found in SLNs has not yet been established and further study is ongoing. The goal of this study was to consider the implication of the isolated tumor cells found in the SLNs of Korean breast cancer patients. Methods: Between September 2003 and March 2008, 985 primary breast cancer patients Underwent SLN biopsy. On reviewing the medical records, 81. patients were found to have ITCs in SLNs without macrometastasis or micrometastasis. ITCs were detected by serial sectioning and immunohistochemistry. Results: The mean number of detected SLNs was 3.5 +/- 1.7. Thirty three patients had multifocally distributed ITCs and 9 had ITCs in multiple SLNs whose N stage was N0 (i+). Completion axillary dissection has been performed in 9 patients and 3 of them (33.3%) finally were found to be N1 or N1mi. Conclusion: The characteristics of ITCs are not clear yet and their prognostic value is still under investigation. Until the significance of ITCs found in SLNs become definite, axillary dissection should be more aggressively considered. (J Korean Surg Soc 2009;77:378-384)
    Article · Dec 2009
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