Abstract
Background: Lymph node status, established by a single hematoxylin and eosin (H&E) section from each node, remains an important prognostic indicator in patients with breast cancer, but used alone it is insufficient to identify patients who will develop metastatic disease. This study was conducted to assess the significance of detecting occult metastases in 86 patients with breast cancer originally reported to be histologically node negative. None of the patients received adjuvant systemic therapy.
Methods: Five additional levels from formalin-fixed, paraffin-embedded nodes were examined at 150-µm intervals with H&E staining and a cocktail of antikeratin antibodies (AE1/AE3) recognizing low molecular weight acidic keratins.
Results: Nodes from 11 (12.8%) of 86 patients contained occult metastases. All metastases identified by cytokeratin antibody were also detected in H&E-stained sections. With median follow-up of 80 months, distant metastases occurred in five of 11 occult node-positive patients (45%) and 13 of 75 patients whose nodes were negative on review (17%). Median time to recurrence was 89 months for occult node-positive patients and not yet reached for node-negative patients (p=0.048). The disease-specific 5-year survival rate was 90% for occult node-positive patients and 95% for node-negative patients.
Conclusions: The presence of occult metastases shortened the disease-free interval and suggested that more diligent axillary staging would more accurately identify patients who would benefit from systemic adjuvant treatment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Valgussa P, Bonadonna G, Veronesi V. Patterns of relapse and survival following radical mastectomy.Cancer 1978;41:1170–8.
Fisher B, Slack N, Katrych D, et al. Ten year follow-up results of patients with carcinoma of the breast in a cooperative clinical trial evaluating surgical adjuvant chemotherapy.Surg Gynecol Obstet 1975;140:528–34.
Nemoto T, Vana J, Bedwani R, et al. Management and survival of female breast cancer: results of a national survey by the American College of Surgeons.Cancer 1980;45:2917–24.
Andersson I, Aspergren K, Janzon L, et al. Mammographic screening and mortality from breast cancer. The Malmo mammographic screening trial.Br Med J 1988;297:943–8.
Fisher B, Slack NH. Number of lymph nodes examined and the prognosis of breast cancer.Surg Gynecol Obstet 1970;131:79–88.
Merkel DE, Winchester DJ, Rademaker AW, et al. DNA flow cytometry and pathologic grading as prognostic guides in node-negative breast cancer.Cancer 1993;72:1926–32.
Fisher B, Bauer M, Wickerham L, et al. Relationship of the number of positive axillary nodes to the prognosis of patients with primary breast cancer.Cancer 1983;52:1151–7.
Saphir O, Amromin GD. Obscure axillary lymph node metastases in carcinoma of breast.Cancer 1948;1:238–41.
Pickren JW. Significance of occult metastases. A study of breast cancer.Cancer 1961;14:1266–71.
Fisher ER, Swamidoss S, Lee CH, et al. Detection and significance of occult axillary node metastases in patients with invasive breast cancer.Cancer 1978;42:2025–31.
Wilkinson EJ, Hause LL, Hoffman RG, et al. Occult axillary lymph node metastases in invasive breast carcinoma: characteristics of the primary tumor and significance of the metastases.Pathol Annu 1982;17:67–91.
Rosen PP, Saigo PE, Braun DW Jr, et al. Occult axillary lymph node metastases from breast cancers with intramammary lymphatic tumor emboli.Am J Surg Pathol 1982;6:639–41.
Wells CA, Heryet J, Brochier J, et al. The immunocytochemical detection of axillary micrometastases in breast cancer.Br J Cancer 1984;50:193–7.
Bussolati G, Gugliotta P, Morra I, et al. The immunohistochemical detection of lymph node metastases from infiltrating lobular carcinoma of the breast.Br J Cancer 1986;54:631–6.
Trojani M, de Mascarel I, Bonichon F, et al. Micrometastases to axillary lymph nodes from carcinoma of breast: detection by immunohistochemistry and prognostic significance.Br J Cancer 1987;55:303–6.
Trojani M, de Mascarel I, Coindre JM, et al. Micrometastases to axillary lymph nodes from invasive lobular carcinoma of the breast: detection by immunohistochemistry and prognostic significance.Br J Cancer 1987;56:838–9.
Sedmak DD, Meineke TA, Knechtges DS, et al. Prognostic significance of cytokeratin-positive breast cancer metastases.Mod Pathol 1989;2:516–20.
International (Ludwig) Breast Cancer Study Group. Prognostic importance of occult axillary lymph node micrometastases from breast cancers.Lancet 1990;335:1565–8.
Hainsworth PJ, Tjandra JJ, Stillwell RG, et al. Detection and significance of occult metastases in node-negative breast cancer.Br J Surg 1993;80:459–63.
Nasser IA, Lee AKC, Bosari S, et al. Occult axillary lymph node metastases in “node-negative” breast carcinoma.Hum Pathol 1993;24:950–7.
Guiliano AE, Dale PS, Turner RR, et al. Improved axillary staging of breast cancer with sentinel lymphadenectomy.Ann Surg 1995;222:394–9.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Clare, S.E., Sener, S.F., Wilkens, W. et al. Prognostic significance of occult lymph node metastases in node-negative breast cancer. Annals of Surgical Oncology 4, 447–451 (1997). https://doi.org/10.1007/BF02303667
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02303667