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Occult Metastases in Sentinel Nodes of 200 Patients With Operable Breast Cancer

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Abstract

Background:Up to 30% of patients with operable breast cancer and negative regional lymph nodes experience disease recurrence within 10 years. Serial sectioning and immunohistochemical staining of these nodes have revealed 9% to 30% occult metastases.

Methods:Sentinel nodes from 200 patients with T1 and T2 invasive breast carcinoma were step-sectioned at 2- to 3-mm intervals, fixed in 10% formalin, and embedded in paraffin. Sections were taken from the face of the blocks and stained with hematoxylin and eosin (H&E). The blocks were then cut completely, and sections at .25-mm intervals were stained with cytokeratin and examined.

Results:Tumor metastases were found in 34 patients when the sentinel nodes were examined at 2- to 3-mm intervals and in an additional 51 patients when the nodes were sectioned in their entirety at .25-mm intervals and stained with cytokeratin, bringing the total number of patients with metastases to 85. Of the 51 patients whose metastases were detected by 2- to 3-mm sectioning and cytokeratin staining, 27 had isolated tumor cells and 24 had clusters of innumerable malignant cells, all of which were visualized and confirmed by H&E staining of the adjacent sections.

Conclusions:Histologic examination of sentinel nodes of patients with invasive breast cancer sectioned at 2- to 3-mm intervals and stained with H&E significantly underestimates nodal metastases. Sectioning of the entire sentinel nodes at .25-mm intervals and staining with cytokeratin detects metastases as either isolated cells or as clusters.

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Authors and Affiliations

  1. Department of General Surgery, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois

    Kambiz Dowlatshahi MD & Ming Fan MD

  2. Department of Pathology, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois

    Joseph M. Anderson MD & Kenneth J. Bloom MD

  3. 1725 W. Harrison Street, Suite 848, Chicago, IL, 60612

    Kambiz Dowlatshahi MD

Authors
  1. Kambiz Dowlatshahi MD
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  2. Ming Fan MD
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  3. Joseph M. Anderson MD
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  4. Kenneth J. Bloom MD
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Correspondence to Kambiz Dowlatshahi MD.

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Dowlatshahi, K., Fan, M., Anderson, J.M. et al. Occult Metastases in Sentinel Nodes of 200 Patients With Operable Breast Cancer. Ann Surg Oncol 8, 675–681 (2001). https://doi.org/10.1007/s10434-001-0675-3

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  • DOI: https://doi.org/10.1007/s10434-001-0675-3

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