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Sentinel lymph nodes with isolated tumour cells and micrometastases in breast cancer: clinical relevance and prognostic significance
  1. Syed Salahuddin Ahmed1,
  2. Aye Aye Thike1,
  3. Jabed Iqbal1,
  4. Wei Sean Yong2,
  5. Benita Tan3,
  6. Preetha Madhukumar2,
  7. Kong Wee Ong2,
  8. Gay Hui Ho2,
  9. Chow Yin Wong3,
  10. Puay Hoon Tan1
  1. 1Department of Pathology, Singapore General Hospital, Singapore
  2. 2Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
  3. 3Department of General Surgery, Singapore General Hospital, Singapore
  1. Correspondence to Dr Syed Salahuddin Ahmed, Pathology Department, Histopathology, Singapore General Hospital, 20 College Road, Academia, Level 10, Diagnostics Tower, 169856, Singapore; syed.salahuddin.ahmed{at}


Aim We performed a retrospective review to determine the prognostic significance of isolated tumour cells (ITCs) and micrometastases to the sentinel lymph nodes of patients with breast cancer.

Methods A total of 1044 patients with a diagnosis of invasive carcinoma of the breast who underwent surgical treatment including the sentinel lymph node biopsy procedure from July 2004 to October 2009 were included in the study.

Results In 710 (68%) patients, no metastasis was seen to the sentinel lymph nodes. ITCs were detected in 22 (2.1%) patients, micrometastasis in 52 (5.0%) and macrometastases in 260 (24.9%). With a median follow-up of 28.8 months, disease recurrence was seen in 38 (3.6%) patients and 15 (1.5%) patients died of disease. No disease recurrence or deaths were recorded in women with ITCs in sentinel lymph nodes. In the micrometastasis group, 2 patients suffered disease recurrence and both died of disease.

Conclusions We conclude that ITCs in the sentinel lymph nodes did not adversely impact disease free and overall survivals. Although only 2 recurrences with subsequent death occurred in the micrometastasis group, it may suggest a propensity for presence of micrometastases to augur a worse outcome, and justifies continued segregation of ITCs from micrometastasis.

  • Breast Cancer
  • Metastasis
  • Lymph Nodes

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