Article

Tan LK, Giri D, Hummer AJ, Panageas KS, Brogi E, Norton L, Hudis C, Borgen PI, Cody III HSOccult axillary node metastases in breast cancer are prognostically significant: results in 368 node-negative patients with 20-year follow-up. J Clin Oncol 26(11): 1803-1809

Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 05/2008; 26(11):1803-9. DOI: 10.1200/JCO.2007.12.6425
Source: PubMed

ABSTRACT

In breast cancer, sentinel lymph node (SLN) biopsy allows the routine performance of serial sections and/or immunohistochemical (IHC) staining to detect occult metastases missed by conventional techniques. However, there is no consensus regarding the optimal method for pathologic examination of SLN, or the prognostic significance of SLN micrometastases.
In 368 patients with axillary node-negative invasive breast cancer, treated between 1976 and 1978 by mastectomy, axillary dissection, and no systemic therapy, we reexamined the axillary tissue blocks following our current pathologic protocol for SLN. Occult lymph node metastases were categorized by pattern of staining (immunohistochemically positive or negative [IHC+/-], hematoxylin-eosin staining positive or negative [H & E +/-]), number of positive nodes (0, 1, > 1), number of metastatic cells (0, 1 to 20, 21 to 100, > 100), and largest cluster size (<or= 0.2 mm [pN0(i+)], 0.3 to 2.0 mm [pN1(mi)], > 2.0 mm [pN1a]). We report 20-year results as overall survival (OS), disease-free survival (DFS), and disease-specific death (DSD).
A total of 23% of patients (83 of 368) were converted to node-positive. Of these, 73% were <or= 0.2 mm in size (pN0(i+)), 20% were 0.3 to 2.0 mm (pN1(mi)), and 6% were more than 2 mm (pN1a). On univariate and multivariate analysis, pattern of staining, number of positive nodes, number of metastatic cells, and cluster size were all significantly related to both DFS and DSD. On multivariate analysis, each of these measures had significance comparable to, or greater than, tumor size, grade or lymphovascular invasion.
In breast cancer patients staged node-negative by conventional single-section pathology, occult axillary node metastases detected by our current pathologic protocol for SLN are prognostically significant.

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    • "However, for evaluation of non-SNs, a more approximate procedure than that for SNs, such as single-section histology without immunohistochemical staining, has been adopted. Although the false-negative rate and underestimation of the metastasis volume can be reduced by serial sectioning and immunohistochemistry (Umekita et al, 2002; Reed et al, 2004; Tan et al, 2008), this procedure forces a heavy workload and cost on technicians and pathologists. The one-step nucleic acid amplification (OSNA) assay (Sysmex Corporation) is a rapid molecular detection procedure that "
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    ABSTRACT: The one-step nucleic acid amplification (OSNA) assay is a molecular-based lymph-node metastasis detection procedure that can assess a whole node and yields semi-quantitative results for the detection of clinically relevant nodal metastases. We aimed to determine the performance of the OSNA assay as an accurate nodal staging tool in comparison with routine histological examination. Subjects comprised 183 consecutive patients with pT1-2 breast cancer who underwent axillary dissection after positive sentinel-node (SN) biopsy with the OSNA assay. Of these, for non-SN evaluation, 119 patients underwent OSNA assay evaluation, whereas 64 had single-section histology. We compared the detection rates of non-SN metastasis and upstaging rates from the SN stage according to the American Joint Committee on Cancer staging between the OSNA and histology cohorts. OSNA detected more cases of non-SN metastases than histology (OSNA 66/119, 55.5% vs histology 13/64, 20.3%; P<0.001), particularly micrometastases (36/119, 30.3% vs 1/64, 1.6%; P<0.001). Total upstaging rates were similar in both cohorts (20/119, 16.8% vs 9/64, 14.1%, P=0.79). OSNA detects a far greater proportion of non-SN micrometastases than routine histological examination. However, upstaging rates after axillary dissection were not significantly different between both cohorts. Follow-up of the OSNA cohort is required to determine its clinical relevance.
    Full-text · Article · Aug 2011 · British Journal of Cancer
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    • "Additional macrometastases were found in 15% and 4%, respectively, resulting in altered treatment in 7% of patients. In a recently published study involving 2408 patients detection of micrometastatic carcinoma was a major indicator of poorer survival [152] . In addition, 9.3% of these patients had additional axillary nodal disease on axillary dissection and decreased survival when axillary dissection was omitted. "
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    ABSTRACT: Biopsy of the sentinel lymph node now forms part of routine management in many centres dealing with early stage breast cancer. This article seeks to discuss developments over the past number of years and to summarise current practice.
    Full-text · Article · Feb 2008 · Cancer Imaging
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    ABSTRACT: Sentinel lymph node (SLN) biopsy has become standard care for axillary lymph node staging, allowing routine, pathologic SLN examination by serial sections (SS) and/or immunohistochemical (IHC) stains. Although these methods increase the accuracy of staging, the prognostic significance of SLN micrometastases (pN0i+ [< 0.2 mm] and pN1mi [0.2–2 mm]), and especially of those detected only by IHC, is controversial. Retrospective studies have addressed this issue by relating survival to size of nodal metastasis, or by using SS and/or IHC to reassess nodes initially staged as negative, and suggest but do not conclusively prove that SLN micrometastases are associated with a modest decrement in overall and/or disease-free survival. Because there is no current standardized protocol for the pathologic assessment of SLN, prospective trials in progress will establish whether SS and/or IHC are worthwhile.
    No preview · Article · Mar 2009 · Current Breast Cancer Reports
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