Relationship Between Histologic Features of Primary Breast Carcinomas and Axillary Lymph Node Micrometastases: Detection and Prognostic Significance
The incidence and prognostic significance of micrometastases (Mic-Met) in axillary lymph nodes (LNs) is still controversial. We compared Mic-Met detection of invasive mammary carcinomas (IMCs) in axillary LNs using second review of hematoxylin and eosin (H&E)-stained slides and immunohistochemistry (IHC) relating them with features of the primary tumor, and determining their influence on overall survival (OS) and disease-free survival (DFS). We studied 188 cases of IMCs with no axillary metastases in the initial reports. The original H&E slides of LN were re-viewed and new sections were submitted for IHC using pancytokeratin (AE1/AE3). All primary breast tumors were re-viewed and classified according to Page et al (1998) and College of American Pathologists criteria (2000). Tumors were graded using the Nottingham grading system. Kaplan-Meier curves were used to evaluate OS and DFS of 147 patients. Mic-Met detection was correlated to histologic features of primary tumor (size, type, grade, lymphatic/blood vessel invasion). Mic-Met were detected in 26/188 cases (by IHC: 23/188, 12.2%; by H&E: 12/188, 6.4%). The re-view of H&E slides showed good specificity (98.2%), but low sensitivity (39.1%), when compared with IHC. There was no relationship between features of primary tumor and Mic-Met detection, including patients with lobular carcinomas or IMCs with lobular features. There was no statistical difference in OS and DFS of patients with and without Mic-Met, but patients with Mic-Met presented lower survival curves. In conclusion, there was no relationship between histologic features of primary tumor and presence of Mic-Met, nor between Mic-Met detection and patients survival.
Available from: Helenice Gobbi
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ABSTRACT: The aim of our study was to analyze morphologic and molecular markers of breast cancer relating them to the presence of metastases in axillary lymph nodes.
We selected 123 cases of invasive mammary carcinomas stratified into three subgroups: with macrometastases, with micrometastases, and lymph node negative. Presence of metastases was evaluated relating them with morphologic factors (size of primary tumor, type and grade, presence of lymphatic and blood vessel invasion in hematoxylin and eosin-stained slides) and molecular factors of primary tumor (estrogen and progesterone receptors, E-cadherin, Ki67, p53, Her2 expression, and the presence of lymphatic and blood vessel invasion in immunostained sections for D2-40 and CD31).
Axillary lymph node metastases were positively related to the presence of lymphatic vessel invasion in hematoxylin and eosin (H&E)-stained slides, when analyzed with or without metastases (p=0.04) and when analyzed in the three subgroups (p=0.002). Lymph node metastases were also positively related to presence of blood vessel invasion identified by immunohistochemistry (IHC) for CD31 (p=0.02). However other morphologic and molecular factors were not related to the presence of axillary node metastases.
Lymphatic and blood vessel invasion identified in H&E and IHC-stained slides are positively related to the rmetastatic status of axillary lymph nodes and are predictive of axillary lymph node metastases in breast cancer.
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ABSTRACT: The presence of para-aortic lymph node metastasis in biliary cancer has a negative impact on prognosis. The relevance of para-aortic lymph node micrometastasis is unknown.
A total of 546 para-aortic lymph nodes from 49 patients with biliary cancer with positive regional nodes and negative para-aortic nodes were immunostained with epithelial marker CAM5.2 (specific for cytokeratins 7 and 8). Immunostained tumour foci were classified as micrometastases or isolated tumour cells (ITCs) according to their size (larger or smaller than 0.2 mm).
CAM5.2-positive occult carcinoma cells in para-aortic lymph nodes were detected in nine (18 per cent) of 49 patients and in 18 (3.3 per cent) of 546 para-aortic nodes. There was no difference in postoperative survival between patients with and without CAM5.2-positive para-aortic nodes (P = 0.978), but survival for five patients with micrometastases was significantly worse than that for four patients with only ITCs (P = 0.047).
In patients with regional node-positive and para-aortic node-negative biliary cancer, and occult cancer cells in para-aortic lymph nodes, prognosis was significantly worse in those with micrometastases than in patients with only ITCs. An efficient method of intraoperative detection of para-aortic lymph node micrometastases larger than 0.2 mm is needed.
Available from: Douglas Soltau Gomes
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ABSTRACT: OBJETIVO: Fazer análise crítica da contribuição da imuno-histoquímica na avaliação de fatores preditivos/prognósticos do câncer de mama, na pesquisa de micrometástases em linfonodos sentinela e no diagnóstico diferencial de lesões mamárias. MÉTODOS: Foi realizado estudo observacional retrospectivo de todos os casos de lesões mamárias e linfonodos sentinelas submetidas a estudo imuno-histoquímico no Laboratório de Patologia Mamária da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG) entre 2001 e 2007. Os casos foram classificados de acordo com a indicação do estudo imuno-histoquímico em três categorias: avaliação de fatores preditivos/prognósticos, pesquisa de células epiteliais metastáticas em linfonodos sentinela e definição diagnóstica. RESULTADOS: Foram realizados exames imuno-histoquímicos de 1.294 casos, totalizando 4.101 reações com 21 anticorpos diferentes. Na maioria dos casos, a imuno-histoquímica foi realizada para avaliação de fatores preditivos/prognósticos (1.106 casos, 85,5%), seguido de pesquisa de células epiteliais metastáticas em linfonodos sentinelas (134 casos, 10,6%) e diagnóstico diferencial de lesões mamárias (51 casos, 3,9%). Obtiveram-se reações de boa qualidade com importante contribuição do estudo imuno-histoquímico em 1.247 casos (96,4%). Em 47 casos (3,6%), o resultado foi inconclusivo devido a problemas de fixação (autólise) da fase pré-analítica. CONCLUSÃO: Nossos dados confirmam ser o estudo imuno-histoquímico importante ferramenta para avaliação de fatores preditivos e prognósticos do câncer de mama, pesquisa de micrometástases em linfonodos sentinelas e diagnóstico diferencial de lesões mamárias. A maior utilização da imuno-histoquímica foi para avaliação de fatores preditivos e prognósticos do câncer de mama.
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