| Abstract: |
The ability to detect micrometastatic breast carcinoma in patients with early-stage disease might help to identify individuals who are at increased risk for progression of their tumor. While conventional staging parameters provide a reliable index about prognosis for groups of patients, they are unable to predict the individuals in any particular stage who will progress. We have used monoclonal antibodies to identify extrinsic carcinoma cells in the bone marrow of patients with operable breast cancer. This assay can identify micrometastases prior to their detection by any other method, including cytologic examination of bone marrow. This method is able to reliably detect two extrinsic cells in a background of one million bone marrow elements. In our initial studies we found extrinsic cells in the bone marrow of 35% (18 of 51) of patients with operable breast carcinoma. Bone b status was compared with conventional prognostic parameters: 27% (6 of 22) patients with negative lymph nodes had extrinsic cells, while 41% (12 of 29) of patients with lymph node metastases had such cells. A similar trend was seen when patients were separated by stage of disease. We have further shown that the presence of bone b micrometastases is significantly predictive of early recurrence. The examination of bone b aspirates with monoclonal antibodies appears to be a clinically important variable which provides information about early recurrence, and may be useful to further stratify patients into adjuvant treatment programs. |
