Annals of Surgical Oncology

, Volume 14, Issue 6, pp 1896–1903

Association of the Presence of Bone Marrow Micrometastases with the Sentinel Lymph Node Status in 410 Early Stage Breast Cancer Patients: Results of the Swiss Multicenter Study


  • Igor Langer
    • Department of SurgeryUniversity Hospital Basel
  • Ulrich Guller
    • Department of SurgeryUniversity Hospital Basel
  • Ossi R. Koechli
    • Bethanien Clinic
  • Gilles Berclaz
    • Division of GynecologyUniversity Hospital Berne
  • Gad Singer
    • Institute of PathologyUniversity Hospital Basel
  • Gabriel Schaer
    • Department of Obstetrics and GynecologyKantonsspital Aarau
  • Mathias K. Fehr
    • Division of GynecologyUniversity Hospital Zurich
  • Thomas Hess
    • Division of GynecologyKantonsspital Winterthur
  • Daniel Oertli
    • Department of SurgeryUniversity Hospital Basel
  • Lucio Bronz
    • Department of Obstetrics and GynecologyOspedale San Giovanni
  • Beate Schnarwyler
    • Maternité, Stadtspital Triemli
  • Edward Wight
    • Division of GynecologyUniversity Hospital Basel
  • Urs Uehlinger
    • Department of Obstetrics and GynecologyKantonsspital Bruderholz
  • Eduard Infanger
    • Department of Obstetrics and GynecologyKantonales Spital Sursee-Wolhusen
  • Daniel Burger
    • Department of Obstetrics and GynecologyKantonales Spital Sursee-Wolhusen
    • Department of SurgeryKantonsspital Olten

DOI: 10.1245/s10434-006-9193-7

Cite this article as:
Langer, I., Guller, U., Koechli, O.R. et al. Ann Surg Oncol (2007) 14: 1896. doi:10.1245/s10434-006-9193-7



The sentinel lymph node (SLN) status has proven to accurately reflect the remaining axillary lymph nodes and represents the most important prognostic factor. It is unknown whether an association exists between the SLN status and the presence of bone marrow (BM) micrometastases. The objective of the present investigation was to evaluate whether or not such an association exists.


In the present investigation 410 patients with early stage breast cancer (pT1 and pT2 ≤3cm, cN0) were prospectively enrolled between 1/2000 and 12/2003. All patients underwent SLN biopsy and bone marrow aspiration. The histological examination of the SLN consisted of step sectioning, H&E, and immunohistochemistry (Lu-5, CK 22) staining. Cancer cells in the BM were stained with monoclonal antibodies A45-B/B3 against cytokeratin and counted by an automated computerized digital microscope.


BM micrometastases were detected in 28.8% (118/410) of all patients. The SLN contained metastases in 32.4% (133/410). Overall 51.2% of the patients (210/410) were SLN negative/BM negative and 12.4% (51/410) SLN positive/BM positive. Of all patients, 16.4% (67/410) were SLN negative/BM positive and 20.0% (82/410) SLN positive/BM negative. There was a statistically significant association between the SLN and BM status, both in unadjusted (Fisher’s exact test: P = .004) and multiple logistic regression analysis (P = .007).


In the present investigation a significant association was found between a positive SLN status and the presence of BM micrometastases. Nonetheless, the percentage of non-concordance (SLN negative/BM positive and SLN positive/BM negative) was considerable. The prognostic impact of BM micrometastases in our patient sample remains to be evaluated.


Breast cancerSentinel lymph nodeBone marrow micrometastasesCorrelationMulticenter trial

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© Society of Surgical Oncology 2007