Annals of Surgical Oncology

, Volume 15, Issue 12, pp 3369–3377 | Cite as

Lymphovascular Invasion and Lobular Histology are Associated with Increased Incidence of Isolated Tumor Cells in Sentinel Lymph Nodes from Early-Stage Breast Cancer Patients

  • Elizabeth A. Mittendorf
  • Aysegul A. Sahin
  • Susan L. Tucker
  • Funda Meric-Bernstam
  • Min Yi
  • Khazi M. Nayeemuddin
  • Gildy V. Babiera
  • Merrick I. Ross
  • Barry W. Feig
  • Henry M. Kuerer
  • Kelly K. Hunt
Breast Oncology



Isolated tumor cells (ITC) are more likely to be identified when serial sectioning and immunohistochemical staining are used to evaluate sentinel lymph nodes (SLN). Our goal was to identify clinicopathologic features associated with ITC in patients undergoing sentinel lymph node dissection (SLND).


We reviewed clinicopathologic data for 3557 patients with no clinical evidence of lymph node metastases undergoing SLND between November 1993 and March 2007. Patients were staged according to the 6th edition of the American Joint Committee on Cancer staging system, with metastasis ≤.2 mm classified as ITC.


A SLN was identified in 3475 patients (97.7%), including 2518 (72.4%) with negative nodes and 169 (4.9%) with ITC. A statistically significant association existed between lobular histology and the identification of ITC; 13.6% of patients with ITC had lobular histology versus 7.3% of patients with a negative SLN (P = .003). The presence of lymphovascular invasion (LVI) was also associated with ITC; 18.3% of patients with ITC had LVI in the primary tumor versus 8.5% of patients with a negative SLN (P < .001). No difference existed between patients with and without ITC with respect to T stage, grade, estrogen receptor, progesterone receptor, HER2/neu status, or biopsy method.


The association between ITC and LVI, a known predictor of poor outcome, suggests ITC may have clinical relevance. The relationship between lobular histology and ITC is consistent with the known pattern of lobular metastases, which frequently present as small foci requiring immunohistochemistry for detection. Longer follow-up is needed to determine whether ITC have prognostic significance.


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Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Elizabeth A. Mittendorf
    • 1
  • Aysegul A. Sahin
    • 2
  • Susan L. Tucker
    • 3
  • Funda Meric-Bernstam
    • 1
  • Min Yi
    • 1
  • Khazi M. Nayeemuddin
    • 1
  • Gildy V. Babiera
    • 1
  • Merrick I. Ross
    • 1
  • Barry W. Feig
    • 1
  • Henry M. Kuerer
    • 1
  • Kelly K. Hunt
    • 1
  1. 1.Department of Surgical Oncology, Unit 444The University of Texas M. D. Anderson Cancer CenterHoustonUSA
  2. 2.Department of PathologyThe University of Texas M. D. Anderson Cancer CenterHoustonUSA
  3. 3.Department of Bioinformatics and Computational BiologyThe University of Texas M. D. Anderson Cancer CenterHoustonUSA

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