Occult Micrometastasis of Sentinel Lymph Node in Node-negative Breast Cancer.
- Author:
Un Jong CHOI
1
;
Won Cheol PARK
;
Kwang Man LEE
;
Ki Jung YOON
Author Information
1. Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea. leekm@wonkwang.ac.kr
- Publication Type:Original Article
- Keywords:
Breast cancer;
Sentinel lymph node;
Occult mir crometastasis
- MeSH:
Biopsy;
Breast Neoplasms*;
Breast*;
Humans;
Incidence;
Keratins;
Lymph Nodes*;
Neoplasm Metastasis;
Neoplasm Micrometastasis*;
Sensitivity and Specificity
- From:Journal of the Korean Surgical Society
2001;61(4):379-386
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Sentinel lymph node (SLN) biopsy is thought to be a highly accurate method of assessing axillary nodal status in breast cancer. Furthermore, it can improve axillary staging by providing a more detailed examination of selected lymph nodes with a high probability of metastasis rather than the entire axillary nodes. The purpose of this study was to assess the incidence of SLN micrometastasis in node-negative breast cancer. METHODS: SLN biopsy was performed in 40 patients with clinically node-negative breast cancer using vital blue dye and/or radioisotope methods; the blue dye method was used in 21 cases, the isotope method in 14 cases, and a combination of both methods in 5 cases. All lymph nodes were evaluated by routine pathologic examination, and a more detailed examination was performed on sentinel nodes in node-negative cases; sentinel nodes were serially sectioned at an interval of 40nm depth followed by H&E and cytokeratin immunohistochemical (IHC) staining. RESULTS: Sentinel nodes were detected in 35 of 40 patients (87.5%). The mapping technique used in the remaining 5 cases was vital blue dye method only. Axillary node metastasis was found in 16 of 40 patients. Sentinel node biopsy accurately reflected the axillary node status in all cases; the sensitivity, specificity, and overall accuracy were 100, 100 and 100%, respectively. In 11 of 16 node-positive patients (68.8%), sentinel nodes were the only metastatic nodes. Occult micrometastases were found in SLN by serial sectionand IHC staining in 4 of 19 patients diagnosed as node- negative by routine pathological examination (21.1%). Occult micrometastasis of SLN was not correlated with primary tumor size, histologic grade or lymphovascular invasion with the exception of the S-phase fraction (P=0.023). CONCLUSION: SLN biopsy was a highly accurate method of assessing axillary node metastasis in breast cancer. Serial sectioning and IHC staining of SLN were sensitive methods in the detection of occult lymph node metastasis.
