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Clinical significance of sentinel lymph node isolated tumour cells in breast cancer

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Abstract

The advent of sentinel lymph node biopsy (SLNB) and improvements in histopathological and molecular analysis have increased the rate at which isolated tumour cells (ITC) are identified. However, their biological and clinical significance has been the subject of much debate. In this article we review the literature concerning SLNB with particular reference to ITC. The controversies regarding histopathological assessment, clinical relevance and management implications are explored. The literature review was facilitated by Medline, PubMed, Embase and Cochrane databases. Published studies have reported divergent results regarding the biological significance and clinical implications of ITC in general and SLN ITC in particular. Some studies demonstrate no associations, whilst others have found these to be indicators of poor prognosis, associated with non-SLN involvement, in addition to local recurrence and distant disease. Absolute consensus regarding the optimal analytical technique for SLN has yet to be reached, particularly concerning immunohistochemical (IHC) techniques targeting cytokeratins and contemporary molecular analysis. The clinical relevance of ITC within the SLN should be primarily determined by the magnitude of their impact on patient management and outcome measures. The modest up-staging within current classification systems is justified and reflects the marginally poorer prognosis for women with SLN ITC. Management need not be altered where further axillary treatment with surgical clearance or radiotherapy and systemic adjuvant treatment are already indicated. However, in the absence of level-1 guidance, each case requires discussion with regard to other tumour and patient related factors in the context of the multidisciplinary team. The identification of ITC remains highly dependent on the analytical technique employed and there exists potential for stage migration and impact on management decisions. Evidence supporting the routine analysis of deeper tissue sections by IHC is lacking and molecular technologies should be restricted to research purposes at present.

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Abbreviations

BC:

Breast cancer

ALND:

Axillary lymph node dissection

SLNB:

Sentinel lymph node biopsy

ITC:

Isolated tumour cells

SLN:

Sentinel lymph nodes

IHC:

Immunohistochemical

RT:

Radiotherapy

LR:

Local recurrence

MM:

Micro-metastasis

AJCC:

American Joint Committee on Cancer

pTNM:

Pathological tumour node metastasis

HES:

Haematoxylin and eosin staining

RT-PCR:

Reverse transcriptase polymerase chain reaction

OSNA:

One-step nucleic acid amplification

TRC:

Transcription-reverse transcription concerted reaction

CEA:

Carcinoembryonic antigen

EWGBSP:

European Working Group for Breast Screening Pathology

RFS:

Recurrence free survival

OS:

Overall survival

DFS:

Disease free survival

SEER:

Surveillance, Epidemiology and End Results

ASCO:

American Society of Clinical Oncology

ACOSOG:

American College of Surgeons Oncology Group

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  1. The London Breast Institute, The Princess Grace Hospital, 45 Nottingham Place, London, W1U 5NY, UK

    Neill Patani & Kefah Mokbel

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Patani, N., Mokbel, K. Clinical significance of sentinel lymph node isolated tumour cells in breast cancer. Breast Cancer Res Treat 127, 325–334 (2011). https://doi.org/10.1007/s10549-011-1476-4

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