Study Shows Advantage of Breast Cancer Staging Method
Current sentinel lymph node biopsy techniques can detect occult nodal metastases
WEDNESDAY, April 9 (HealthDay News) -- In breast cancer patients who were staged node-negative by conventional single-section pathology, current sentinel lymph node biopsy techniques detect occult axillary node metastases that are prognostically significant, according to an article published in the April 10 issue of the Journal of Clinical Oncology.
Lee K. Tan, M.D., of Memorial Sloan-Kettering Cancer Center in New York City, and colleagues used current pathologic protocols to re-examine axillary tissue blocks from 368 patients with breast cancer treated between 1976 and 1978 with mastectomy, axillary dissection and no systemic therapy, who were deemed node-negative at the time by conventional single-section pathology. The researchers categorized occult lymph node metastases by current criteria and correlated findings with overall survival, disease-free survival and disease-specific death.
Occult lymph nodal metastases were identified in 23 percent of patients, the report indicates. The pattern of staining (immunohistochemical and hematoxylin-eosin [H&E]), number of positive nodes, number of metastatic cells and cluster size were all significantly associated with worsened disease-free survival and higher disease-specific death rates. The prognostic significance of these measures were equal to or greater than tumor size, grade or lymphovascular invasion.
While awaiting data from blinded studies comparing routine H&E examination of the sentinel lymph node to serial sections with immunohistochemical staining in present-day patients, the authors conclude that "the benefits of sentinel lymph node examination by serial sections and immunohistochemical [staining] far outweigh the risks."