Current Breast Cancer Reports

, Volume 2, Issue 2, pp 96–106

Sentinel Node and Bone Marrow Micrometastases and Nanometastases

  • Elia Biganzoli
  • Massimo Pedriali
  • Patrizia Querzoli
  • Italo Nenci
  • Stefano Iacobelli
  • Mauro Piantelli
  • Saverio Alberti
Article

DOI: 10.1007/s12609-010-0013-5

Cite this article as:
Biganzoli, E., Pedriali, M., Querzoli, P. et al. Curr Breast Cancer Rep (2010) 2: 96. doi:10.1007/s12609-010-0013-5

Abstract

Step-sectioning and anti-cytokeratin immunohistochemistry allow detection of micrometastases and nanometastases down to the single cell level, but they are labor intensive and time consuming. Reverse-transcription polymerase chain reaction can be performed efficiently, but it cannot currently detect less than several thousand cancer cells per lymph node. Improvements in molecular assays are thus required for reliable use in clinical settings. Whole-axilla dissection maximizes chances of detecting micrometastases and nanometastases. However, sentinel lymph node analysis provides an important fraction of this information in more convenient surgical and laboratory settings. Nanometastases have been shown to be a risk factor for event-free survival and for metastatic relapse. Thus, a re-evaluation of current TNM staging procedures appears needed. Corresponding therapeutic strategies should be tested accordingly in prospective clinical trials with adequate follow-up time. Microinvasion of the bone marrow is an independent prognostic indicator for disease recurrence and death from cancer, but bone marrow analyses are poorly suited to monitor disease course and response to therapy. The detection of circulating tumor cells has been shown to provide useful prognostic information, but it correlates poorly with bone marrow microinvasion, and the latter remains an independent, albeit hard to manage, prognostic determinant.

Keywords

Breast cancer Metastasis Lymph nodes Bone marrow Prognosis Markers 

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Elia Biganzoli
    • 1
  • Massimo Pedriali
    • 2
  • Patrizia Querzoli
    • 2
  • Italo Nenci
    • 2
  • Stefano Iacobelli
    • 3
  • Mauro Piantelli
    • 3
  • Saverio Alberti
    • 3
    • 4
  1. 1.Unit of Medical Statistics and Biometry, National Cancer Institute of Milano and Institute of Medical Statistics and BiometryUniversity of MilanoMilanItaly
  2. 2.Department of Experimental and Diagnostic Medicine, Surgical PathologyUniversity of FerraraFerraraItaly
  3. 3.Department of Oncology and Neurosciences, BAMS“G. d’Annunzio” Chieti University FoundationChietiItaly
  4. 4.Unit of Cancer Pathology, Center of Excellence in Research on AgingUniversity “G. d’ Annunzio”Chieti Scalo (Chieti)Italy

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