Annals of Surgical Oncology

, Volume 14, Issue 6, pp 1896–1903 | Cite as

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
  • Ulrich Guller
  • Ossi R. Koechli
  • Gilles Berclaz
  • Gad Singer
  • Gabriel Schaer
  • Mathias K. Fehr
  • Thomas Hess
  • Daniel Oertli
  • Lucio Bronz
  • Beate Schnarwyler
  • Edward Wight
  • Urs Uehlinger
  • Eduard Infanger
  • Daniel Burger
  • Markus Zuber



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 cancer Sentinel lymph node Bone marrow micrometastases Correlation Multicenter trial 



Funding through SAKK, the Swiss Group for Clinical Cancer Research, Berne, Switzerland and the Cancer League of Basel-Stadt and Basel-Land, Basel, Switzerland. The authors thank Guido Sauter, MD, pathologist for initiation of the bone marrow protocol and Rosmarie Chaffard, technician at the Institute of Pathology, University Hospital Basel, for her technical assistance with the analysis of the BM aspirates. We also thank Bernadette von Felten, study nurse at the Department of Surgery, University Hospital Basel, for collecting patients’ data.


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Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Igor Langer
    • 1
  • Ulrich Guller
    • 1
  • Ossi R. Koechli
    • 2
  • Gilles Berclaz
    • 3
  • Gad Singer
    • 4
  • Gabriel Schaer
    • 5
  • Mathias K. Fehr
    • 6
  • Thomas Hess
    • 7
  • Daniel Oertli
    • 1
  • Lucio Bronz
    • 8
  • Beate Schnarwyler
    • 9
  • Edward Wight
    • 10
  • Urs Uehlinger
    • 11
  • Eduard Infanger
    • 12
  • Daniel Burger
    • 12
  • Markus Zuber
    • 13
  1. 1.Department of SurgeryUniversity Hospital BaselBaselSwitzerland
  2. 2.Bethanien ClinicZurichSwitzerland
  3. 3.Division of GynecologyUniversity Hospital BerneBerneSwitzerland
  4. 4.Institute of PathologyUniversity Hospital BaselBaselSwitzerland
  5. 5.Department of Obstetrics and GynecologyKantonsspital AarauAarauSwitzerland
  6. 6.Division of GynecologyUniversity Hospital ZurichZurichSwitzerland
  7. 7.Division of GynecologyKantonsspital WinterthurWinterthurSwitzerland
  8. 8.Department of Obstetrics and GynecologyOspedale San GiovanniBellinzonaSwitzerland
  9. 9.Maternité, Stadtspital TriemliZurichSwitzerland
  10. 10.Division of GynecologyUniversity Hospital BaselBaselSwitzerland
  11. 11.Department of Obstetrics and GynecologyKantonsspital BruderholzBinningenSwitzerland
  12. 12.Department of Obstetrics and GynecologyKantonales Spital Sursee-WolhusenWolhusenSwitzerland
  13. 13.Department of SurgeryKantonsspital OltenOltenSwitzerland

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