Occult axillary node metastases in breast cancer are prognostically significant: Results in 368 node-negative patients with 20-year follow-up Journal Article


Authors: Tan, L. K.; Giri, D.; Hummer, A. J.; Panageas, K. S.; Brogi, E.; Norton, L.; Hudis, C.; Borgen, P. I.; Cody, H. S. 3rd
Article Title: Occult axillary node metastases in breast cancer are prognostically significant: Results in 368 node-negative patients with 20-year follow-up
Abstract: Purpose: 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. Patients and Methods: 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 (≤ 0.2 mm [pN0i+], 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). Results: A total of 23% of patients (83 of 368) were converted to node-positive. Of these, 73% were ≤ 0.2 mm in size (pN0i+), 20% were 0.3 to 2.0 mm (pN1mi), 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. Conclusion: 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. © 2008 by American Society of Clinical Oncology.
Keywords: survival; controlled study; human tissue; disease-free survival; survival rate; major clinical study; mortality; systemic therapy; disease free survival; follow up; follow-up studies; lymph node metastasis; lymph node dissection; lymphatic metastasis; cancer grading; sentinel lymph node; sentinel lymph node biopsy; metastasis; breast cancer; mastectomy; tumor volume; pathology; breast neoplasms; axillary lymph node; survival time; breast tumor; lung carcinoma; axilla; paget nipple disease; carcinoma, ductal; carcinoma, lobular
Journal Title: Journal of Clinical Oncology
Volume: 26
Issue: 11
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2008-04-10
Start Page: 1803
End Page: 1809
Language: English
DOI: 10.1200/jco.2007.12.6425
PUBMED: 18332473
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 64" - "Export Date: 17 November 2011" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Amanda J Hummer
    60 Hummer
  2. Clifford Hudis
    840 Hudis
  3. Larry Norton
    562 Norton
  4. Lee K Tan
    131 Tan
  5. Hiram S Cody III
    209 Cody
  6. Dilip D Giri
    122 Giri
  7. Patrick I Borgen
    232 Borgen
  8. Katherine S Panageas
    327 Panageas
  9. Edi Brogi
    304 Brogi