Breast Cancer Research and Treatment

, Volume 132, Issue 2, pp 621–624 | Cite as

Absence of ectopic epithelial inclusions in 3,904 axillary lymph nodes examined in sentinel technique

  • Sonja Iken
  • Marcus Schmidt
  • Claudia Braun
  • Antonietta Valentino
  • Hans-Anton Lehr
  • Stephan C. Schaefer
Clinical Trial


Intraoperative examination of sentinel axillary lymph nodes can be done by imprint cytology, frozen section, or, most recently, by PCR-based amplification of a cytokeratin signal. Using this technique, benign epithelial inclusions, representing mammary tissue displaced along the milk line, will likely generate a positive PCR signal and lead to a false-positive diagnosis of metastatic disease. To better appreciate the incidence of ectopic epithelial inclusions in axillary lymph nodes, we have performed an autopsy study, examining on 100 μm step sections 3,904 lymph nodes obtained from 160 axillary dissections in 80 patients. The median number of lymph nodes per axilla was 23 (15, 6, and 1 in levels 1, 2, and 3, respectively). A total of 30,450 hematoxylin-eosin stained slides were examined, as well as 8,825 slides immunostained with pan-cytokeratin antibodies. Despite this meticulous work-up, not a single epithelial inclusion was found in this study, suggesting that the incidence of such inclusions is much lower than the assumed 5% reported in the literature.


Benign epithelial inclusions Sentinel lymph node Polymerase chain reaction Autopsy Axillary lymph nodes 



We are grateful to Aziz Chaouch (University Institute of Social and Preventive Medicine, Lausanne) for helping with the statistical data analysis. This study is part of the doctoral dissertation of Sonja Iken (University of Mainz, Mainz, Germany). Sonja Iken has performed the axillary dissections in the autopsy suite under guidance and close supervision of Marcus Schmidt and analyzed all the histological and immunohistochemical slides. Claudia Braun and Antonietta Valentino have provided the technical platform for the histological work-up and the immunohistochemical analyses. Hans-Anton Lehr and Stephan Schaefer have planned the study, advised Sonja Iken during her doctoral dissertation, verified the histological and immunohistochemical analyses, and written the article. All authors have read and approved the final manuscript. The authors wish to express their deep gratitude to Prof. C. James Kirkpatrick, chairman of the department of pathology, for providing an atmosphere of scientific curiosity and immense freedom, in which this and many other studies could flourish.

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Rubio IT, Korourian S, Cowan C (1998) Use of touch preps for intraoperative diagnosis of sentinel lymph node metastases in breast cancer. Ann Surg Oncol 5:689–694PubMedCrossRefGoogle Scholar
  2. 2.
    Cserni G, Amendoeira I, Apostolikas N (2003) Pathological work-up of sentinel lymph nodes in breast cancer: review of current data to be considered for the formulation of guidelines. Eur J Cancer 39:1654–1667PubMedCrossRefGoogle Scholar
  3. 3.
    Julian TB, Blumencranz P, Deck K, Whitworth P, Berry DA, Berry SM, Rosenberg A, Chagpar AB, Reintgen D, Beitsch P, Simmons R, Saha S, Mamounas EP, Giuliano A (2008) Novel intraoperative molecular test for sentinel lymph node metastases in patients with early-stage breast cancer. J Clin Oncol 26:3338–3345PubMedCrossRefGoogle Scholar
  4. 4.
    Rutty GN (1994) Benign lymph node inclusions. J Pathol 173:301–302PubMedCrossRefGoogle Scholar
  5. 5.
    Markopoulos C, Kouskos E, Kontzoglou K, Gogas G, Kyriakou V, Gogas J (2001) Breast cancer in ectopic breast tissue. Eur J Gynaecol Oncol 22:157–159PubMedGoogle Scholar
  6. 6.
    Maiorano E, Mazzarol GM, Pruneri G, Mastropasqua MG, Zurrida S, Orvieto E, Viale G (2003) Ectopic breast tissue as a possible cause of false-positive axillary sentinel lymph node biopsies. Am J Surg Pathol 27:513–518PubMedCrossRefGoogle Scholar
  7. 7.
    Fellegra G, Carcangiu ML, Rosai J (2011) Benign epithelial inclusions in axillary lymph nodes: report of 18 cases and review of the literature. Am J Surg Pathol 35:1123–1133CrossRefGoogle Scholar
  8. 8.
    Peng Y, Ashfaq R, Ewing G, Leitch AM, Molberg KH (2008) False-positive sentinel lymph nodes in breast cancer patients caused by benign glandular inclusions: report of three cases and review of the literature. Am J Clin Pathol 130:21–27PubMedCrossRefGoogle Scholar
  9. 9.
    Chen J, Yang B, Chen J, Zhang J, Li D, Xu W, Xu X, Yang W, Shao Z, Wang Y, Wu J (2011) A prospective comparison of molecular assay and touch imprint cytology for intraoperative evaluation of sentinel lymph nodes. Chinese Med J 124:491–497Google Scholar
  10. 10.
    Tyalma WA, Senten LL (2006) The management of ectopic breast cancer-case report. Eur J Gynaecol Oncol 27:414–416Google Scholar
  11. 11.
    Turner RR, Ollila DW, Krasne DL, Giuliano AE (1997) Histopathologic validation of the sentinel lymph node hypothesis for breast carcinoma. Ann Surg 226:271–278PubMedCrossRefGoogle Scholar
  12. 12.
    Viale G, Bosari S, Mazzarol G, Galimberti V, Luini A, Veronesi P, Paganelli G, Bodoni M, Orvieto E (1999) Intraoperative examination of axillary sentinel lymph nodes in breast carcinoma patients. Cancer 85:2433–2438PubMedCrossRefGoogle Scholar
  13. 13.
    Cappello F, Bellafiore M, Palma A, Marciano V, Zummo G, Farina F, Bucchieri F (2001) Study of axillary lymph node asymmetry in a female population. J Anat 199:617–620PubMedCrossRefGoogle Scholar
  14. 14.
    Misnik WP (1980) Geschlechtliche und altersbedingte Besonderheiten der axillären Lymphknoten beim erwachsenen Menschen. Anat Anz 147:100–106PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Sonja Iken
    • 1
    • 3
  • Marcus Schmidt
    • 2
  • Claudia Braun
    • 1
    • 4
  • Antonietta Valentino
    • 1
  • Hans-Anton Lehr
    • 1
    • 6
  • Stephan C. Schaefer
    • 1
    • 5
  1. 1.Department of PathologyJohannes Gutenberg University, Medical SchoolMainzGermany
  2. 2.Department of GynecologyJohannes Gutenberg University, Medical SchoolMainzGermany
  3. 3.Department of Anaesthesiology, Intensive Care and Pain MedicineUniversity of FrankfurtFrankfurtGermany
  4. 4.Core Facility Histology, Department of DermatologyJohannes Gutenberg UniversityMainzGermany
  5. 5.Institute of PathologyUniversity of BernBernSwitzerland
  6. 6.Institute of PathologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland

Personalised recommendations