Immunohistochemically detected tumor cells in the sentinel lymph nodes of patients with breast carcinoma: Biologic metastasis or procedural artifact? Journal Article

  

Authors:	Moore, K. H.; Thaler, H. T.; Tan, L. K.; Borgen, P. I.; Cody, H. S. 3rd
Article Title:	Immunohistochemically detected tumor cells in the sentinel lymph nodes of patients with breast carcinoma: Biologic metastasis or procedural artifact?
Abstract:	BACKGROUND. Sentinel lymph node (SLN) biopsy is a new standard of care for patients with breast carcinoma, and allows enhanced pathologic analysis with serial sections and immunohistochemical (IHC) staining for cytokeratins to be performed on a routine basis. However, the significance of SLN micrometastases detected only by IHC is uncertain. Are these tumor cells truly markers of metastatic potential, or simply evidence of passive displacement by preoperative instrumentation of the tumor site? Here we evaluate whether the pattern of SLN metastasis in breast carcinoma is related to the degree of manipulation at biopsy before surgery, independently of other known predictors. METHODS. Among 4016 consecutive eligible patients with breast carcinoma registered in a prospective SLN database at Memorial Sloan Kettering Cancer Center, we noted patient/tumor characteristics, pathologic status of the SLN (negative, positive by hematoxylin and eosin [H&E], or positive only on IHC), and method of previous biopsy (none, fine-needle aspiration biopsy [FNAB], core needle biopsy, or surgical biopsy). RESULTS. Multivariate analysis showed that the likelihood of an H&E-positive SLN was significantly associated with lymphovascular invasion, tumor size, tumor type, and tumor location, but not with the method of biopsy. In contrast, the likelihood of finding an SLN positive only on IHC was unassociated with any of the four variables above, but was significantly associated with the method of biopsy. After no previous biopsy, FNAB, core needle biopsy, or surgical biopsy, IHC-positive SLN were present in 1.2%, 3.0%, 3.8%, and 4.6% of patients, respectively (P = 0.002). CONCLUSIONS. These data suggest that the frequency of IHC-positive SLN in patients with breast carcinoma 1) is unrelated to conventional predictors of lymph node positivity, 2) is increased after instrumentation of the tumor site, and 3) is increased approximately proportionate to the degree of manipulation. A proportion of IHC-positive SLN were present before biopsy and therefore less likely to be artifactual. © 2004 American Cancer Society.
Keywords:	immunohistochemistry; adult; human tissue; aged; middle aged; major clinical study; lymph node metastasis; cancer diagnosis; lymph nodes; lymphatic metastasis; neoplasm staging; sensitivity and specificity; sentinel lymph node; prospective studies; sentinel lymph node biopsy; disease association; tumor localization; tumor volume; logistic models; breast neoplasms; cancer invasion; registries; probability; biopsy, needle; breast carcinoma; tumor cell; carcinoma; multivariate analysis; eosin; hematoxylin; neoplasm invasiveness; cytokeratin; aspiration biopsy; analysis of variance; micrometastases; humans; prognosis; human; female; priority journal; article; epithelial displacement
Journal Title:	Cancer
Volume:	100
Issue:	5
ISSN:	0008-543X
Publisher:	Wiley Blackwell
Date Published:	2004-03-01
Start Page:	929
End Page:	934
Language:	English
DOI:	10.1002/cncr.20035
PROVIDER:	scopus
PUBMED:	14983487
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-1242336809&partnerID=40&md5=0f881a0d31bbad8b7c84daeee35fb1e4
Notes:	Cancer -- Cited By (since 1996):69 -- Export Date: 16 June 2014 -- CODEN: CANCA -- Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/53387